M97.8XXA — Periprosthetic fracture around other internal prosthetic joint, initial encounter
M97.8XXA is a billable, specific ICD-10-CM code for periprosthetic fracture around other internal prosthetic 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
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
M97.8XXA 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
M97.8XXA is named in 6 Medicare coverage policies — 0 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 M97.8. If M97.8XXA is not quite right, the correct code is usually one of these.
Questions about M97.8XXA
- Is M97.8XXA a billable ICD-10-CM code?
- Yes. M97.8XXA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M97.8XXA 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).