Is M97.8 a billable ICD-10-CM code?

No. M97.8 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does M97.8 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).

M97.8

M97.8 — Periprosthetic fracture around other internal prosthetic joint

Non-billable headerICD-10-CM

M97.8 is a non-billable header ICD-10-CM code for periprosthetic fracture around other 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

Use additional code

Add a secondary code to capture the detail described below.

code to identify the joint (Z96.6-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Periprosthetic fracture around internal prosthetic finger joint
Periprosthetic fracture around internal prosthetic spinal joint
Periprosthetic fracture around internal prosthetic toe joint
Periprosthetic fracture around internal prosthetic wrist joint

Risk adjustment

M97.8 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.

How M97.8 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to M97.8.

Fracture, pathological›periprosthetic›finger
Fracture, pathological›periprosthetic›other specified joint
Fracture, pathological›periprosthetic›spinal joint
Fracture, pathological›periprosthetic›toe joint
Fracture, pathological›periprosthetic›wrist joint
Fracture, traumatic›periprosthetic, around internal prosthetic joint›finger
Fracture, traumatic›periprosthetic, around internal prosthetic joint›specified joint NEC
Fracture, traumatic›periprosthetic, around internal prosthetic joint›spine
Fracture, traumatic›periprosthetic, around internal prosthetic joint›toe
Fracture, traumatic›periprosthetic, around internal prosthetic joint›wrist

Code to one of these instead M97.8

3 child codes. Green means billable.

Related codes at this level

Codes that share M97. If M97.8 is not quite right, the correct code is usually one of these.

Questions about M97.8

Is M97.8 a billable ICD-10-CM code?: No. M97.8 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does M97.8 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).