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.
Check M97.8XXA 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
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
Excludes2 inherited from the categories above M97.8XXA
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with M97.8XXA
Their own Excludes1 notes name this code, so the conflict is not listed above.
- T84.01Broken internal joint prosthesis
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
M97.8XXA is named in 7 Medicare coverage policies: 0 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.