M97.0 vs S72
M97.0 (Periprosthetic fracture around internal prosthetic hip joint) compared with S72 (Fracture of femur), 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. S72 carries an Excludes2 note covering M97.0: “periprosthetic fracture of prosthetic implant of hip (M97.0-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| M97.0Periprosthetic fracture around internal prosthetic hip joint | S72Fracture of femur | |
|---|---|---|
| Billing status | Non-billable header Report instead: M97.01XA, M97.01XD, M97.01XS, M97.02XA, M97.02XD | Non-billable header Report instead: S72.001A, S72.001B, S72.001C, S72.001D, S72.001E |
| Classification | M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Periprosthetic fracture around internal prosthetic hip joint is a non-billable ICD-10-CM category code (M97.0). | Fracture of femur is a non-billable ICD-10-CM category code (S72). |
| 7th character | The appropriate 7th character is to be added to each code from category M97 | The appropriate 7th character is to be added to all codes from category S72 |
| 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