Podiatry Coding & Billing Alert

ICD-10-CM:

Stress Fractures Involve Repetitive Stress or Force on Bone Caused by Overuse

Published on Wed Jan 20, 2021

“A” character indicated an initial encounter for a fracture.

If your podiatrist sees patients for fractures in your office, you need to be aware of specific details such as the differences between the types of fractures and what the characters indicate in the ICD-10-CM fracture codes.

Read on to learn about a specific type of fracture — stress fractures.

Differentiate Between Stress and Other Fractures

When reporting stress fractures, you must first check the medical documentation to verify that the fracture is indeed a stress fracture and not another type. Your ICD-10-CM coding options are different depending upon the fracture.

Stress fracture defined: Stress fractures are tiny cracks in the bone caused by repetitive stress or force, often from overuse. These often occur in normal or metabolically weakened bones. Patients may have a stress fracture without even realizing it. When a patient has a stress fracture, they usually complain of pain that is nagging or gradually building. You would look to M84.37- (Stress fracture, ankle, foot and toes).

Don’t miss: If you look under M84.3- (Stress fracture) in the ICD-10-CM manual, you will see that fatigue fractures, March fractures, stress fractures NOS, and stress reactions are all included conditions for this code.

For traumatic fractures for podiatry patients, you would look to codes S82- (Fracture of lower leg, including ankle) and S92- (Fracture of foot and toe, except ankle).

Pathological fractures defined: A pathological fracture is a broken bone that’s caused by a disease, rather than trauma. If reporting a pathological fracture, you must double check the documentation for the underlying cause of the disease. Osteoporosis and neoplastic diseases are two common examples of diseases that can cause a pathological fracture.

For example, the medical documentation indicates that your podiatrist saw a patient with age-related osteoporosis who is suffering from a current pathological fracture of her left ankle. This is a subsequent encounter with delayed healing. You would report M80.072G (Age-related osteoporosis with current pathological fracture, left ankle and foot, subsequent encounter for fracture with delayed healing) on your claim.

Know Stress Fracture Character Requirements

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

Understand How Podiatrists Diagnose Stress Fractures, Treatment Options

When diagnosing a stress fracture, the most common scenario is an office evaluation and management (E/M) service and an X-ray.

During the E/M visit, the podiatrist will ask the patient for his history, including his work and reactional activities and conduct a physical exam. Podiatrists may also use a laboratory exam of the patient’s blood for calcium and vitamin D levels.

Treatment options: Treatment options for stress fractures can include lifestyle modification, rest, a splint or cast for immobilization, special shoes that support the arch and ankles, and nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain.

Putting it All Together With An Example

Example: During a level-three office visit for a new patient, the podiatrist diagnoses a stress fracture to the patient’s right ankle. The patient has been walking long distances for exercise recently and has been experiencing a gradual building of pain in her ankle. The podiatrist also performs a two-view X-ray of the ankle before arriving to this diagnosis. This is an initial encounter. The podiatrist spent 42 minutes on the patient encounter on that date of service. For this encounter, you’d report:

73600 (Radiologic examination, ankle; 2 views) for the X-ray.
99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter) for the E/M.
M84.371A (Stress fracture, right ankle, initial encounter for fracture) to represent the patient’s stress fracture.