M97.02XA — Periprosthetic fracture around internal prosthetic left hip joint, initial encounter
M97.02XA is a billable, specific ICD-10-CM code for periprosthetic fracture around internal prosthetic left hip joint, initial encounter. It is valid for submission on a claim.
7th 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
Risk adjustment
M97.02XA 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.
Medicare coverage
M97.02XA is named in 13 Medicare coverage policies — 7 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing 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
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Related codes at this level
Codes that share M97.02. If M97.02XA is not quite right, the correct code is usually one of these.
Questions about M97.02XA
- Is M97.02XA a billable ICD-10-CM code?
- Yes. M97.02XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M97.02XA 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).