M97

M97: Periprosthetic fracture around internal prosthetic joint

Non-billable headerICD-10-CM

M97 is a non-billable header ICD-10-CM code for periprosthetic fracture around internal prosthetic joint. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

The appropriate 7th character is to be added to each code from category M97

A: initial encounter
D: subsequent encounter
S: sequela

Excludes2: not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-)
breakage (fracture) of prosthetic joint (T84.01-)

Code first

The underlying condition must be sequenced before this code.

, if known, the specific type and cause of fracture, such as traumatic or pathological

Other codes that can never be billed with M97

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

T84.01Broken internal joint prosthesis

Risk adjustment

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

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead M97

7 child codes. Green means billable.