M96.6 vs M97.8XXS
M96.6 (Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate) compared with M97.8XXS (Periprosthetic fracture around other internal prosthetic joint, sequela), 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 M97.8XXS: “periprosthetic fracture around internal prosthetic joint (M97.-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Yes, when both are documented. M97.8XXS 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 | M97.8XXSPeriprosthetic fracture around other internal prosthetic joint, sequela | |
|---|---|---|
| Billing status | Non-billable header | Billable |
| 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 other internal prosthetic joint, sequela is a billable ICD-10-CM diagnosis code (M97.8S). |
| 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 | 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 |
| Use additional code | — | code to identify the joint (Z96.6-) |
| 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