M84.38XS: Stress fracture, other site, sequela
M84.38XS is a billable, specific ICD-10-CM code for stress fracture, other site, sequela. It is valid for submission on a claim.
Check M84.38XS with the rest of the claim: free scrubber7th character "S": sequela
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 M84.38XS
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above M84.38XS
Not part of this code, but both may be coded when both are present.
Written on M84.3: Stress fracture
Written on M84: Disorder of continuity of bone
- traumatic fracture of bone-see fracture, by site
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
M84.38XS is named in 13 Medicare coverage policies: 6 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- 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
Unchanged in every release from FY2024 to FY2027.
Other codes under M84.38
- M84.38XAStress fracture, other site, initial encounter for fracture
- 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