M96.6 vs M97
M96.6 (Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate) compared with M97 (Periprosthetic fracture around internal prosthetic joint), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Can these codes be reported together?
Yes, when both are documented. M96.6 carries an Excludes2 note covering M97: “periprosthetic fracture around internal prosthetic joint (M97.-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Yes, when both are documented. M97 carries an Excludes2 note covering M96.6: “fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| M96.6Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate | M97Periprosthetic fracture around internal prosthetic joint | |
|---|---|---|
| Billing status | Non-billable header | Non-billable header Report instead: M97.01XA, M97.01XD, M97.01XS, M97.02XA, M97.02XD |
| Classification | M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) | M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) |
| Definition | Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate is a non-billable ICD-10-CM category code (M96.6). | Periprosthetic fracture around internal prosthetic joint is a non-billable ICD-10-CM category code (M97). |
| 7th character | — | The appropriate 7th character is to be added to each code from category M97 |
| Includes | Intraoperative fracture of bone during insertion of orthopedic implant, joint prosthesis, or bone plate | — |
| Code first | — | , if known, the specific type and cause of fracture, such as traumatic or pathological |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources