M97.8XXS vs T84.01
M97.8XXS (Periprosthetic fracture around other internal prosthetic joint, sequela) 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.
Can these codes be reported together?
Yes, when both are documented. M97.8XXS 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 M97.8XXS: “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
| M97.8XXSPeriprosthetic fracture around other internal prosthetic joint, sequela | T84.01Broken internal joint prosthesis | |
|---|---|---|
| Billing status | Billable | Non-billable header Report instead: T84.010A, T84.010D, T84.010S, T84.011A, T84.011D |
| 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 other internal prosthetic joint, sequela is a billable ICD-10-CM diagnosis code (M97.8S). | 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 | 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 | Breakage (fracture) of prosthetic joint Broken prosthetic joint implant |
| Use additional code | code to identify the joint (Z96.6-) | 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 | — |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources