Podiatry Coding & Billing Alert

Question: I’m new to podiatry. Could you please explain the difference between stress, pathological, and traumatic fractures? Also, which ICD-10-CM codes should I look at for fractures?

California Subscriber

Answer: It’s really important to carefully check your podiatrist’s medical documentation when a patient has a fracture because you will report different ICD-10-CM codes for the different types of fractures.

Stress fractures 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) to report stress fractures of the foot.

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.

Traumatic fractures defined: A fracture is considered traumatic when it is caused by some type of accident, fall, or other kind of force, such as when a heavy object strikes a patient. For traumatic fractures for podiatry patients, you should look to categories S82- (Fracture of lower leg, including ankle) and S92- (Fracture of foot and toe, except ankle) to choose the appropriate ICD-10-code for the diagnosis.