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M97.22XD vs T84.01

M97.22XD (Periprosthetic fracture around internal prosthetic left ankle joint, subsequent encounter) compared with T84.01 (Broken internal joint prosthesis), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes should not be reported together because T84.01’s tabular entry lists M97.22XD under Excludes1.

Official rule
What is different?

The conditions named, billing status and chapter.M97.22XD is “Periprosthetic fracture around internal prosthetic left ankle joint, subsequent encounter”; T84.01 is “Broken internal joint prosthesis”. T84.01 is a non-billable header; M97.22XD is billable. M97.22XD sits in M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99); T84.01 in S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88).

Registry fact

Can these codes be reported together?

No.T84.01’s entry carries an Excludes1 note covering M97.22XD: “periprosthetic joint implant fracture (M97.-)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.T84.01’s tabular entry: “periprosthetic joint implant fracture (M97.-)”. The note covers M97.22XD.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

Yes.M97.22XD’s tabular entry: “breakage (fracture) of prosthetic joint (T84.01-)”. The note covers T84.01.

Official ruleGuide: Excludes1 vs Excludes2

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.T84.01 is a non-billable header, but M97.22XD is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Excludes1 — generally not reported together

Excludes1 conflict

T84.01
Broken internal joint prosthesis
↔
M97.22XD
Periprosthetic fracture around internal prosthetic left ankle joint, subsequent encounter

What we found

No — do not report together.T84.01 carries an Excludes1 note covering M97.22XD: “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).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

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

Informational

Excludes2 relationship

M97.22XD
Periprosthetic fracture around internal prosthetic left ankle joint, subsequent encounter
↔
T84.01
Broken internal joint prosthesis

What we found

Yes, when both are documented.M97.22XD 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.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

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 / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2027

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
M97.22XD

Periprosthetic fracture around internal prosthetic left ankle joint, subsequent encounter

T84.01

Broken internal joint prosthesis

StatusDiffers
M97.22XD
Billable
T84.01
Non-billable header

A header is not reported on a claim; a code beneath it is.

Report instead: T84.010A, T84.010D, T84.010S, T84.011A, T84.011D

Excludes1Differs
M97.22XD

None at this code

T84.01
  • periprosthetic joint implant fracture (M97.-)
Excludes2Differs
M97.22XD
  • fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-)
  • breakage (fracture) of prosthetic joint (T84.01-)
T84.01
  • failure and rejection of transplanted organs and tissues (T86.-)
  • fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6)
  • any encounters with medical care for postprocedural conditions in which no complications are present, such as:
  • artificial opening status (Z93.-)
  • closure of external stoma (Z43.-)
  • fitting and adjustment of external prosthetic device (Z44.-)
  • burns and corrosions from local applications and irradiation (T20-T32)
  • complications of surgical procedures during pregnancy, childbirth and the puerperium (O00-O9A)
  • mechanical complication of respirator [ventilator] (J95.850)
  • poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4 or 6)
  • postprocedural fever (R50.82)
  • specified complications classified elsewhere, such as:
  • cerebrospinal fluid leak from spinal puncture (G97.0)
  • colostomy malfunction (K94.0-)
  • disorders of fluid and electrolyte imbalance (E86-E87)
  • functional disturbances following cardiac surgery (I97.0-I97.1)
  • intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)
  • ostomy complications (J95.0-, K94.-, N99.5-)
  • postgastric surgery syndromes (K91.1)
  • postlaminectomy syndrome NEC (M96.1)
  • postmastectomy lymphedema syndrome (I97.2)
  • postsurgical blind-loop syndrome (K91.2)
  • ventilator associated pneumonia (J95.851)
Code firstDiffers
M97.22XD
  • , if known, the specific type and cause of fracture, such as traumatic or pathological
T84.01

None at this code

Use additional codeDiffers
M97.22XD

None at this code

T84.01
  • 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)
CategoryDiffers
M97.22XD

M97 Periprosthetic fracture around internal prosthetic joint

T84.01

T84 Complications of internal orthopedic prosthetic devices, implants and grafts

ChapterDiffers
M97.22XD

M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

T84.01

S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)

IncludesDiffers
M97.22XD

None at this code

T84.01
  • Breakage (fracture) of prosthetic joint
  • Broken prosthetic joint implant
7th characterDiffers
M97.22XD
  • The appropriate 7th character is to be added to each code from category M97
T84.01
  • The appropriate 7th character is to be added to each code from category T84

No Code also note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, notes every code shares are dimmed.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources