ICD 10 Coding Alert

The term “stress fracture” may be confusing to some people, but you can round out your knowledge by refreshing yourself on these specifics.

Read on for more information on how to define stress fractures and how providers end up with such a diagnosis.

Navigate the Stress Fracture Dx Group

The stress fracture diagnosis code section begins with ICD-10 code M84.3- (Stress fracture). From there, the code group explodes into several variations to account for stress fractures in different anatomical areas, on different sides of the body, etc.

“A stress fracture would be considered a fracture that many times is chronic in nature and nondisplaced. Many times, people have stress fractures without realizing it,” explains Wayne Conway, CPC, CRC, CGSC, COSC, senior physician coding specialist at WakeMed Physicians Practice in Raleigh, North Carolina.

The main chief complaint for people who end up diagnosed with stress fractures is pain — and it’s usually a nagging or gradually building pain. “There usually is not a sudden or traumatic event that causes a stress fracture. Stress fractures many times are caused by overuse or sudden overuse,” Conway says.

Example: Someone who does not walk often begins walking five miles a day. This could cause a stress fracture, as “many times stress fractures occur to our weight-bearing bones in the lower extremities,” according to Conway.

Remember that stress fractures are different from typical “traumatic” fractures. “Stress fractures are usually chronic in nature and are usually caused by overuse,” says Conway. “An accident causes a traumatic fracture. For example, car accident, fall down some stairs or even a fall from standing. Usually, a traumatic fracture is caused by a forceful blow to the effected bone and will result in displacement of the fracture.”

Follow the Diagnostic Pathway

When diagnosing a stress fracture, the most common scenario is an office evaluation and management (E/M) service and an X-ray. “Sometimes stress fractures are harder to diagnosis and an X-ray is helpful since there is no apparent traumatic event that caused the fracture,” according to Conway.

7th character alert: When you are coding for certain conditions, such as stress fractures, ICD-10 requires a seventh character. There are half a dozen seventh characters for stress fractures, compared the trio of seventh-character options for many other codes. The seventh-character options for stress fractures are:

• A: Initial encounter for fracture
• D: Subsequent encounter for fracture with routine healing
• G: Subsequent encounter for fracture with delayed healing
• K: Subsequent encounter for fracture with nonunion
• P: Subsequent encounter for fracture with malunion
• S: Sequela.