M97.01XA: Periprosthetic fracture around internal prosthetic right hip joint, initial encounter
M97.01XA is a billable, specific ICD-10-CM code for periprosthetic fracture around internal prosthetic right hip joint, initial encounter. It is valid for submission on a claim.
Check M97.01XA with the rest of the claim: free scrubber7th character "A": initial encounter
The appropriate 7th character is to be added to each code from category M97
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Excludes2 inherited from the categories above M97.01XA
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with M97.01XA
Their own Excludes1 notes name this code, so the conflict is not listed above.
- T84.01Broken internal joint prosthesis
Risk adjustment
M97.01XA risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 402 Hip Fracture/Dislocation0.467 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
M97.01XA 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
Code history
Unchanged in every release from FY2024 to FY2027.