Health data standards and systems

Diagnosis on discharge summary: right subtrochanteric fracture neck of femur due to bisphosphonates.
Progress notes state: HOPC tripped on footpath. Patient on bisphosphonates appearance of fracture characteristic of bisphosphonate fracture.

There is no index entry for Fracture due to drug or Fracture drug induced. Therefore, this would be coded as a traumatic fracture following index:
Fracture
-femur
- - subtrochanteric S72.2
together with Y54.7 adverse effect of bisphosphonates in therapeutic use and other applicable external cause codes.

Research indicates that a bisphosphonate fracture is a type of insufficiency fracture and that an insufficiency fracture is a type of stress fracture (which is the result of normal stresses on abnormal bone).

Question:
Can we code fractures due to bisphosphonates to stress fractures?

VICC advises that in order to assign M84.3- Stress fracture, not elsewhere classified, the term 'stress' needs to be documented.

As you have noted, there is no Index entry for fracture due to drugs, therefore VICC agrees that the correct diagnosis code for the fracture is S72.2 Subtrochanteric fracture.