M84.38XA — Stress fracture, other site, initial encounter for fracture
M84.38XA is a billable, specific ICD-10-CM code for stress fracture, other site, initial encounter for fracture. It is valid for submission on a claim.
7th character "A" — initial encounter for fracture
The appropriate 7th character is to be added to each code from subcategory M84.3:
- 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
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- stress fracture of vertebra (M48.4-)
Excludes1 inherited from the categories above M84.38XA
These are not written on M84.38XA, but they bind it: a note on a category applies to every code beneath it. Billing M84.38XA with anything listed here is a denial.
Excludes2 inherited from the categories above M84.38XA
Also inherited, and the opposite of Excludes1: these conditions are not part of M84.38XA, but a patient can have both, so you may code both.
Written on M84.3 — Stress fracture
Written on M84 — Disorder of continuity of bone
- traumatic fracture of bone-see fracture, by site
Risk adjustment
M84.38XA does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
M84.38XA is named in 9 Medicare coverage policies — 2 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Code history
M84.38XA has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share M84.38. If M84.38XA is not quite right, the correct code is usually one of these.
- M84.38XDStress fracture, other site, subsequent encounter for fracture with routine healing
- M84.38XGStress fracture, other site, subsequent encounter for fracture with delayed healing
- M84.38XKStress fracture, other site, subsequent encounter for fracture with nonunion
- M84.38XPStress fracture, other site, subsequent encounter for fracture with malunion
- M84.38XSStress fracture, other site, sequela
Questions about M84.38XA
- Is M84.38XA a billable ICD-10-CM code?
- Yes. M84.38XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M84.38XA sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Disorders of bone density and structure (M80-M85).
- What cannot be coded together with M84.38XA?
- M84.38XA carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above M84.38XA (M84.3) and apply to it just the same.