ICD-10 Coding for Metatarsal Fracture(S92.30XA, S92.351A)
Complete ICD-10-CM coding and documentation guide for Metatarsal Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Metatarsal Fracture
S92.3-S92.35Primary Range
Fracture of metatarsal bone
This range covers fractures of the metatarsal bones, including specific codes for each metatarsal and laterality.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S92.30XA | Unspecified fracture of metatarsal bone, initial encounter | Use when the specific metatarsal bone is not identified in the documentation. |
|
| S92.351A | Displaced fracture of base of fifth metatarsal bone, right foot, initial encounter | Use when the fracture is specifically identified as a displaced fracture of the fifth metatarsal base. |
|
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 metatarsal fracture
Essential facts and insights about Metatarsal Fracture
Primary ICD-10-CM Codes for metatarsal fracture
Decision Criteria
documentation Criteria
- Documentation must specify 'unspecified metatarsal fracture'.
Applicable To
- Unspecified metatarsal fracture
Excludes
- Stress fracture of metatarsal (M84.37-)
Clinical Validation Requirements
- X-ray or CT confirming fracture
- Clinical documentation of foot pain and swelling
Code-Specific Risks
- Risk of under-documentation if specific bone is not identified.
Coding Notes
- Ensure documentation specifies laterality and encounter type.
S92.351A - Displaced fracture of base of fifth metatarsal bone, right foot, initial encounter
Use when the fracture is specifically identified as a displaced fracture of the fifth metatarsal base.
Applicable To
- Jones fracture
Excludes
- Avulsion fracture of tuberosity of fifth metatarsal (S92.33-)
Clinical Validation Requirements
- X-ray showing fracture at the base of the fifth metatarsal
- Clinical notes indicating displacement
Coding Notes
Ensure documentation specifies the type of fracture and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Metatarsal Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S92.30XA.
Impact
Clinical: May affect treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Always review imaging reports for displacement details.
Impact
Reimbursement: Claims may be denied if 'S' is used incorrectly., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on patient outcomes.
Mitigation Strategy
Use 'S' suffix only if there's a new condition resulting from the fracture.
Impact
Failure to document laterality can lead to audit issues.
Mitigation Strategy
Implement mandatory fields for laterality in EMR systems.
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 Metatarsal Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Metatarsal Fracture
Use these documentation templates to ensure complete and accurate documentation for Metatarsal Fracture. These templates include all required elements for proper coding and billing.
Initial encounter for displaced fracture
Specialty: OrthopedicsRequired Elements
- Anatomical location
- Type of fracture
- Displacement status
- Laterality
- Encounter type
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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