Periprosthetic fracture around internal prosthetic joint
chapter 13: Diseases of the Musculoskeletal System and Connective Tissue
36 billable codes under M97: 12 are a CC; 2 map to HCC 402 (Hip Fracture/Dislocation).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.
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Instructional notes
Excludes2: not included here, code separately if applicable
Code first: code the underlying condition first, then this code
- if known, the specific type and cause of fracture, such as traumatic or pathological
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Covers site and laterality, acute injury versus chronic musculoskeletal conditions, 7th characters for pathologic fractures, osteoporosis with or without current fracture, and multisystem inflammatory syndrome.
- Site and laterality (page 60)
- Acute traumatic versus chronic or recurrent musculoskeletal conditions (page 61)
- Coding of Pathologic Fractures (page 61)
- Osteoporosis (page 61)
- Multisystem Inflammatory Syndrome (page 62)
All codes under M97
M97 can't be used on a claim. Pick a billable code below; grey headings group them.
- M97.0Periprosthetic fracture around internal prosthetic hip joint
- M97.01Periprosthetic fracture around internal prosthetic right hip joint
- M97.01XAPeriprosthetic fracture around internal prosthetic right hip joint, initial encounter
- M97.01XDPeriprosthetic fracture around internal prosthetic right hip joint, subsequent encounter
- M97.01XSPeriprosthetic fracture around internal prosthetic right hip joint, sequela
- M97.02Periprosthetic fracture around internal prosthetic left hip joint
- M97.02XAPeriprosthetic fracture around internal prosthetic left hip joint, initial encounter
- M97.02XDPeriprosthetic fracture around internal prosthetic left hip joint, subsequent encounter
- M97.02XSPeriprosthetic fracture around internal prosthetic left hip joint, sequela
- M97.1Periprosthetic fracture around internal prosthetic knee joint
- M97.11Periprosthetic fracture around internal prosthetic right knee joint
- M97.11XAPeriprosthetic fracture around internal prosthetic right knee joint, initial encounter
- M97.11XDPeriprosthetic fracture around internal prosthetic right knee joint, subsequent encounter
- M97.11XSPeriprosthetic fracture around internal prosthetic right knee joint, sequela
- M97.12Periprosthetic fracture around internal prosthetic left knee joint
- M97.12XAPeriprosthetic fracture around internal prosthetic left knee joint, initial encounter
- M97.12XDPeriprosthetic fracture around internal prosthetic left knee joint, subsequent encounter
- M97.12XSPeriprosthetic fracture around internal prosthetic left knee joint, sequela
- M97.2Periprosthetic fracture around internal prosthetic ankle joint
- M97.21Periprosthetic fracture around internal prosthetic right ankle joint
- M97.21XAPeriprosthetic fracture around internal prosthetic right ankle joint, initial encounter
- M97.21XDPeriprosthetic fracture around internal prosthetic right ankle joint, subsequent encounter
- M97.21XSPeriprosthetic fracture around internal prosthetic right ankle joint, sequela
- M97.22Periprosthetic fracture around internal prosthetic left ankle joint
- M97.22XAPeriprosthetic fracture around internal prosthetic left ankle joint, initial encounter
- M97.22XDPeriprosthetic fracture around internal prosthetic left ankle joint, subsequent encounter
- M97.22XSPeriprosthetic fracture around internal prosthetic left ankle joint, sequela
- M97.3Periprosthetic fracture around internal prosthetic shoulder joint
- M97.31Periprosthetic fracture around internal prosthetic right shoulder joint
- M97.31XAPeriprosthetic fracture around internal prosthetic right shoulder joint, initial encounter
- M97.31XDPeriprosthetic fracture around internal prosthetic right shoulder joint, subsequent encounter
- M97.31XSPeriprosthetic fracture around internal prosthetic right shoulder joint, sequela
- M97.32Periprosthetic fracture around internal prosthetic left shoulder joint
- M97.32XAPeriprosthetic fracture around internal prosthetic left shoulder joint, initial encounter
- M97.32XDPeriprosthetic fracture around internal prosthetic left shoulder joint, subsequent encounter
- M97.32XSPeriprosthetic fracture around internal prosthetic left shoulder joint, sequela
- M97.4Periprosthetic fracture around internal prosthetic elbow joint
- M97.41Periprosthetic fracture around internal prosthetic right elbow joint
- M97.41XAPeriprosthetic fracture around internal prosthetic right elbow joint, initial encounter
- M97.41XDPeriprosthetic fracture around internal prosthetic right elbow joint, subsequent encounter
- M97.41XSPeriprosthetic fracture around internal prosthetic right elbow joint, sequela
- M97.42Periprosthetic fracture around internal prosthetic left elbow joint
- M97.42XAPeriprosthetic fracture around internal prosthetic left elbow joint, initial encounter
- M97.42XDPeriprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter
- M97.42XSPeriprosthetic fracture around internal prosthetic left elbow joint, sequela
- M97.8Periprosthetic fracture around other internal prosthetic joint
- M97.8XXAPeriprosthetic fracture around other internal prosthetic joint, initial encounter
- M97.8XXDPeriprosthetic fracture around other internal prosthetic joint, subsequent encounter
- M97.8XXSPeriprosthetic fracture around other internal prosthetic joint, sequela
- M97.9Periprosthetic fracture around unspecified internal prosthetic joint
- M97.9XXAPeriprosthetic fracture around unspecified internal prosthetic joint, initial encounter
- M97.9XXDPeriprosthetic fracture around unspecified internal prosthetic joint, subsequent encounter
- M97.9XXSPeriprosthetic fracture around unspecified internal prosthetic joint, sequela
M97 MS-DRGs
As the principal diagnosis, the billable codes under M97 group to MS-DRG 559, 560, 561, 922, or 923 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
- DRG 559 Aftercare, Musculoskeletal System and Connective Tissue with MCC (24 of 36 codes)
- DRG 560 Aftercare, Musculoskeletal System and Connective Tissue with CC (24 of 36 codes)
- DRG 561 Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC (24 of 36 codes)
- DRG 922 Other Injury, Poisoning and Toxic Effect Diagnoses with MCC (12 of 36 codes)
- DRG 923 Other Injury, Poisoning and Toxic Effect Diagnoses without MCC (12 of 36 codes)
Other codes that refer to M97
Notes on these codes point to M97.
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
Fractures
A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.
Read more about fractures on MedlinePlusCode history
Added in FY2017 (effective October 1, 2016). No changes since.