Is M97 a billable ICD-10-CM code?

No. M97 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M97 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Periprosthetic fracture around internal prosthetic joint (M97).

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

These codes carry an Excludes1 note pointing at M97. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M97 alone.

T84.01Broken internal joint prosthesis

Risk adjustment

M97 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead M97

7 child codes. Green means billable.

Questions about M97

Is M97 a billable ICD-10-CM code?: No. M97 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M97 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Periprosthetic fracture around internal prosthetic joint (M97).