M97.22XA — Periprosthetic fracture around internal prosthetic left ankle joint, initial encounter
M97.22XA is a billable, specific ICD-10-CM code for periprosthetic fracture around internal prosthetic left ankle 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
Excludes2 inherited from the categories above M97.22XA
Also inherited, and the opposite of Excludes1: these conditions are not part of M97.22XA, but a patient can have both, so you may code both.
Other codes that can never be billed with M97.22XA
These codes carry an Excludes1 note pointing at M97.22XA. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M97.22XA alone.
- T84.01Broken internal joint prosthesis
Risk adjustment
M97.22XA 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.
Medicare coverage
M97.22XA is named in 7 Medicare coverage policies — 0 listing it as supporting medical necessity, and 7 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
- 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
M97.22XA has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share M97.22. If M97.22XA is not quite right, the correct code is usually one of these.
Questions about M97.22XA
- Is M97.22XA a billable ICD-10-CM code?
- Yes. M97.22XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M97.22XA 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).