ED Coding and Reimbursement Alert

Question: If the encounter notes indicate the patient suffered a stress fracture to their left ankle, should I report standard fracture ICD-10 codes? Or are there specific codes for stress fractures?

Missouri Subscriber

Answer: You would not use standard fracture codes for stress fractures, as they have their own ICD-10 code set: M84.3- (Stress fracture). For this patient, report M84.372A (Stress fracture, left ankle, initial encounter for fracture).

According to ICD-10, providers might refer to stress fractures within the documentation by several other terms, including:

• Fatigue fracture,
• March fracture,
• Stress fracture NOS, or
• Stress reaction.

Just like their codes, the causes of stress fractures are very different from standard fractures. Stress fractures occur due to repetitive stress or overuse of a bone, often resulting from activities like running or jumping. Standard fractures, on the other hand, are typically caused by a sudden impact or trauma to the bone, such as a fall or a direct blow.

Example: For traumatic — non-stress — fractures, look to the S82.- (Fracture of lower leg, including ankle) codes. For an encounter for a nondisplaced bimalleolar fracture of the right ankle you would choose code S82.844A (Nondisplaced bimalleolar fracture of right lower leg, initial encounter for closed fracture).