M96.65

M96.65: Fracture of pelvis following insertion of orthopedic implant, joint prosthesis, or bone plate

Billable / specific codeICD-10-CM

M96.65 is a billable, specific ICD-10-CM code for fracture of pelvis following insertion of orthopedic implant, joint prosthesis, or bone plate. It is valid for submission on a claim.

Check M96.65 with the rest of the claim: free scrubber

Excludes2 inherited from the categories above M96.65

Not part of this code, but both may be coded when both are present.

Written on M96.6: Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate

complication of internal orthopedic devices, implants or grafts (T84.-)

Written on M96: Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified

arthropathy following intestinal bypass (M02.0-)
complications of internal orthopedic prosthetic devices, implants and grafts (T84.-)
disorders associated with osteoporosis (M80)
periprosthetic fracture around internal prosthetic joint (M97.-)
presence of functional implants and other devices (Z96-Z97)

Other codes that can never be billed with M96.65

Their own Excludes1 notes name this code, so the conflict is not listed above.

M40Kyphosis and lordosis

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

M96.65 is named in 14 Medicare coverage policies: 7 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered

Alphabetic index entries that lead here

Fracture, traumatic›following insertion of orthopedic implant, joint prosthesis or bone plate›pelvis
Fracture, traumatic›pelvis, pelvic›following insertion of implant, prosthesis or plate

Code history

Unchanged in every release from FY2024 to FY2027.