M97.4 vs S52
M97.4 (Periprosthetic fracture around internal prosthetic elbow joint) compared with S52 (Fracture of forearm), 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. S52 carries an Excludes2 note covering M97.4: “periprosthetic fracture around internal prosthetic elbow joint (M97.4)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| M97.4Periprosthetic fracture around internal prosthetic elbow joint | S52Fracture of forearm | |
|---|---|---|
| Billing status | Non-billable header Report instead: M97.41XA, M97.41XD, M97.41XS, M97.42XA, M97.42XD | Non-billable header Report instead: S52.001A, S52.001B, S52.001C, S52.001D, S52.001E |
| 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 elbow joint is a non-billable ICD-10-CM category code (M97.4). | Fracture of forearm is a non-billable ICD-10-CM category code (S52). |
| 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 S52 |
| 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