ICD-10 Coding for Fifth Metatarsal Fracture(S92.354A, S92.355A)
Complete ICD-10-CM coding and documentation guide for Fifth Metatarsal Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fifth Metatarsal Fracture
S92.35-Primary Range
Fracture of fifth metatarsal bone
This range covers all types of fractures specific to the fifth metatarsal, including laterality, displacement, and encounter type.
Stress fracture, foot
Used for stress fractures of the foot, which require differentiation from traumatic fractures.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S92.354A | Nondisplaced fracture of fifth metatarsal bone, right foot, initial encounter for closed fracture | Use for initial encounter of a nondisplaced fracture of the right fifth metatarsal. |
|
| S92.355A | Nondisplaced fracture of fifth metatarsal bone, left foot, initial encounter for closed fracture | Use for initial encounter of a nondisplaced fracture of the left fifth metatarsal. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for fifth metatarsal fracture
Essential facts and insights about Fifth Metatarsal Fracture
Primary ICD-10-CM Codes for fifth metatarsal fracture
Decision Criteria
clinical Criteria
- Presence of a nondisplaced fracture confirmed by imaging
documentation Criteria
- Explicit mention of 'nondisplaced' and 'right foot' in the medical record
Applicable To
- Nondisplaced fracture of the right fifth metatarsal
Excludes
- Stress fracture of the right fifth metatarsal (M84.375A)
Clinical Validation Requirements
- X-ray confirmation of nondisplaced fracture
- Documentation of trauma mechanism
Code-Specific Risks
- Incorrect laterality documentation
- Misclassification of encounter type
Coding Notes
- Ensure documentation specifies laterality, displacement, and encounter type.
S92.355A - Nondisplaced fracture of fifth metatarsal bone, left foot, initial encounter for closed fracture
Use for initial encounter of a nondisplaced fracture of the left fifth metatarsal.
Applicable To
- Nondisplaced fracture of the left fifth metatarsal
Excludes
- Stress fracture of the left fifth metatarsal (M84.376A)
Clinical Validation Requirements
- X-ray confirmation of nondisplaced fracture
- Documentation of trauma mechanism
Coding Notes
Ensure documentation specifies laterality, displacement, and encounter type.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on same level from slipping, tripping and stumbling, initial encounter
W01.XXXADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fifth Metatarsal Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S92.354A.
Impact
Clinical: Misrepresents the stage of treatment., Regulatory: Non-compliance with ICD-10 coding guidelines., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Verify encounter type before coding., Educate staff on encounter definitions.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Inaccurate data for clinical and research purposes.
Mitigation Strategy
Always specify 'right' or 'left' in the medical record.
Impact
Using initial encounter codes for subsequent visits.
Mitigation Strategy
Implement regular training on encounter coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Fifth Metatarsal Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fifth Metatarsal Fracture
Use these documentation templates to ensure complete and accurate documentation for Fifth Metatarsal Fracture. These templates include all required elements for proper coding and billing.
Initial Encounter for Nondisplaced Fracture
Specialty: OrthopedicsRequired Elements
- Laterality
- Displacement status
- Encounter type
- Mechanism of injury
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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