M97.21XA vs T84.01

M97.21XA (Periprosthetic fracture around internal prosthetic right ankle joint, initial encounter) compared with T84.01 (Broken internal joint prosthesis), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.

Relationship

Conflict

Excludes1 conflict

T84.01

Broken internal joint prosthesis

↔

M97.21XA

Periprosthetic fracture around internal prosthetic right ankle joint, initial encounter

Not coded here — these two are mutually exclusive.

“periprosthetic joint implant fracture (M97.-)”

An Excludes1 note means the two conditions cannot occur together, so the pair should not be reported for the same encounter. The sole exception is when the conditions are documented as unrelated to each other.

Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Informational

Excludes2 relationship

M97.21XA

Periprosthetic fracture around internal prosthetic right ankle joint, initial encounter

↔

T84.01

Broken internal joint prosthesis

Distinct conditions — both may be reported.

“breakage (fracture) of prosthetic joint (T84.01-)”

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source: CMS ICD-10-CM tabular instructional notes

Can these codes be reported together?

Yes, when both are documented. M97.21XA carries an Excludes2 note covering T84.01: “breakage (fracture) of prosthetic joint (T84.01-)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

No — do not report together. T84.01 carries an Excludes1 note covering M97.21XA: “periprosthetic joint implant fracture (M97.-)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Side by side

	M97.21XAPeriprosthetic fracture around internal prosthetic right ankle joint, initial encounter	T84.01Broken internal joint prosthesis
Billing status	Billable	Non-billable header
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 right ankle joint, initial encounter is a billable ICD-10-CM diagnosis code (M97.21A).	Broken internal joint prosthesis is a non-billable ICD-10-CM category code (T84.01).
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 each code from category T84
Includes	—	Breakage (fracture) of prosthetic joint Broken prosthetic joint implant
Use additional code	—	code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) code(s) to identify the specified condition resulting from the complication code to identify devices involved and details of circumstances (Y62-Y82)
Code first	, if known, the specific type and cause of fracture, such as traumatic or pathological	—

Edit this comparison Check a whole claim

Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources