Question: After a level three evaluation and management (E/M) service for a new patient with forearm pain and a magnetic resonance imaging (MRI) of the left arm, the physician diagnoses a bone bruise in the forearm. What exactly is a bone bruise? I didn’t think bones could bruise. Idaho Subscriber Answer: Yes, bruises can penetrate the surface of the skin and affect subcutaneous layers all the way down to the bone. According to the University of Rochester Medical Center, “a bone bruise is a traumatic injury to a bone. It’s less severe than a bone fracture.” Providers might also refer to the injury as a “microfracture” in the encounter notes. On your claim, you would report: More info: “You might think of a black and blue mark on your skin when you hear the word bruise, but bruises can also happen in muscle and bone. This happens when an injury damages small blood vessels and causes blood and fluid to leak into the nearby tissues and blood vessels,” according to URMC. “Deep inside the bone is an area called the medulla. It contains the bone marrow and fibrous tissue called trabeculae. With a bone fracture, all of the trabeculae in a region of bone have broken. But with a bone bruise, an injury only damages some of these trabeculae,” URMC explains. Diagnosing these types of injuries is a fairly new phenomenon, with the advent of magnetic resonance imaging (MRI) testing; bone bruises won’t show up on computed tomography (CT) scans.