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M96.639 ICD-10-CM Code: Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
6 Excludes2
Risk adjustment
CMS-HCC V22 category 176

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 559 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC (MDC 08)
  • MS-DRG 560 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC (MDC 08)
  • MS-DRG 561 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC (MDC 08)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M96.639 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on M96.639 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for M96.639

MedCoder structured workflow — derived from this code’s own official record

Before you code M96.639

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, M96.639 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewM96.631, M96.632

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: unspecified). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewM96.631 · right, M96.632 · left

    Guide: Laterality coding →

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — M96.639 is appropriate when the documentation goes no further.

    ReviewM96.631, M96.632

  2. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewM96.631 · right, M96.632 · left

Consider M96.639. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
Open or closed; displaced or nondisplaced
Defaults apply when the record is silent: closed, and displaced (Guidelines I.C.19.c).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of M96.639(6 notes)

    Coding workflow: The conditions named in this note are not included in M96.639. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareT84, M02.0, M80, M97

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewM96.631, M96.632

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewM96.631 · right, M96.632 · left

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm is a billable ICD-10-CM diagnosis code (M96.639).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name M96.639 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 12 Excludes1 notes: M40 — Kyphosis and lordosis (via M96.-), M86 — Osteomyelitis (via M96.-), M86-M90 — Other osteopathies (M86-M90) (via M96.-), M87 — Osteonecrosis (via M96.-), M88 — Osteitis deformans [Paget's disease of bone] (via M96.-), M89 — Other disorders of bone (via M96.-), M90 — Osteopathies in diseases classified elsewhere (via M96.-), M91 — Juvenile osteochondrosis of hip and pelvis (via M96.-), M91-M94 — Chondropathies (M91-M94) (via M96.-), M92 — Other juvenile osteochondrosis (via M96.-), M93 — Other osteochondropathies (via M96.-), M94 — Other disorders of cartilage (via M96.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 12 Excludes2 notes across 2 chapters: M95 — Other acquired deformities of musculoskeletal system and connective tissue (via M96.-), M97 — Periprosthetic fracture around internal prosthetic joint (via M96.6.-), T80 — Complications following infusion, transfusion and therapeutic injection (via M96.-), T80-T88 — Complications of surgical and medical care, not elsewhere classified (T80-T88) (via M96.-), T81 — Complications of procedures, not elsewhere classified (via M96.-), T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts (via M96.-), T83 — Complications of genitourinary prosthetic devices, implants and grafts (via M96.-), T84 — Complications of internal orthopedic prosthetic devices, implants and grafts (via M96.-), T85 — Complications of other internal prosthetic devices, implants and grafts (via M96.-), T86 — Complications of transplanted organs and tissue (via M96.-), T87 — Complications peculiar to reattachment and amputation (via M96.-), T88 — Other complications of surgical and medical care, not elsewhere classified (via M96.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 191 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 559 (MDC 08), DRG 560 (MDC 08), DRG 561 (MDC 08).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MUS037 — Postprocedural or postoperative musculoskeletal system complication (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

H95.88 — Other intraoperative complications and disorders of the ear and mastoid process, not elsewhere classified, H95.89 — Other postprocedural complications and disorders of the ear and mastoid process, not elsewhere classified, I97.3 — Postprocedural hypertension, L76.81 — Other intraoperative complications of skin and subcutaneous tissue, L76.82 — Other postprocedural complications of skin and subcutaneous tissue, M96.621 — Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm, M96.622 — Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm, M96.629 — Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm, M96.631 — Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm, M96.632 — Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm, M96.65 — Fracture of pelvis following insertion of orthopedic implant, joint prosthesis, or bone plate, M96.661 — Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg, M96.662 — Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg, M96.669 — Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified leg, M96.671 — Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg, M96.672 — Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg, M96.679 — Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified leg, M96.69 — Fracture of other bone following insertion of orthopedic implant, joint prosthesis, or bone plate, M96.89 — Other intraoperative and postprocedural complications and disorders of the musculoskeletal system, M97.01XA — Periprosthetic fracture around internal prosthetic right hip joint, initial encounter, +170 more

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

M96.631 — Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm (right)Compare M96.639 vs M96.631 →, M96.632 — Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm (left)Compare M96.639 vs M96.632 →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Postprocedural or postoperative musculoskeletal system complication).

M96.1 — Postlaminectomy syndrome, not elsewhere classified, M96.2 — Postradiation kyphosis, M96.3 — Postlaminectomy kyphosis, M96.4 — Postsurgical lordosis, M96.5 — Postradiation scoliosis, M96.621 — Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm, M96.622 — Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm, M96.629 — Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm, M96.631 — Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm, M96.632 — Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm, M96.65 — Fracture of pelvis following insertion of orthopedic implant, joint prosthesis, or bone plate, M96.661 — Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg, M96.662 — Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg, M96.669 — Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified leg, M96.671 — Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg, M96.672 — Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg, M96.679 — Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified leg, M96.69 — Fracture of other bone following insertion of orthopedic implant, joint prosthesis, or bone plate, M96.810 — Intraoperative hemorrhage and hematoma of a musculoskeletal structure complicating a musculoskeletal system procedure, M96.811 — Intraoperative hemorrhage and hematoma of a musculoskeletal structure complicating other procedure, +10 more

Contextual Map

Every relationship of M96.639 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run M96.639 with these 16 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (12)

Referenced by Excludes2 notes (12)

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue[MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 18,508 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M96.639 in its code family, with their registry titles.

View all codes in the M96 family