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ICD-10/M97.42XA

M97.42XA ICD-10-CM Code: Periprosthetic fracture around internal prosthetic left elbow joint, initial encounter

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

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, 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.

Official Registry Overview & Definition

Periprosthetic fracture around internal prosthetic left elbow joint, initial encounter is a billable ICD-10-CM diagnosis code (M97.42A).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for M97.42XA in the official ICD-10-CM tabular list.

Excludes2 — Not Included Here

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

Code First

Underlying conditions that must be sequenced before this code.

  • Code first, if known, the specific type and cause of fracture, such as traumatic or pathological

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Periprosthetic fracture around internal prosthetic left elbow joint, initial encounter
    FY2017 changes

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.

Contextual Map

Every relationship of M97.42XA 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.

Hierarchy

  • M00-M99 — Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) (M00-M99) [Hierarchy]
  • M97-M97 — Periprosthetic fracture around internal prosthetic joint [Hierarchy]

Referenced by Excludes1 notes

  • T84.01 — Broken internal joint prosthesis [Excludes1](via M97.-): “periprosthetic joint implant fracture (M97.-)” · check together

Referenced by Excludes2 notes

  • M96 — Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified [Excludes2](via M97.-): “periprosthetic fracture around internal prosthetic joint (M97.-)” · check together

Clinical classification (CCSR)

  • INJ004 — Fracture of the upper limb, initial encounter [CCSR]

Potential MS-DRG

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”
  • DRG 559 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC [MS-DRG]: “AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC (MDC 08)”
  • DRG 560 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC [MS-DRG]: “AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC (MDC 08)”
  • DRG 561 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC [MS-DRG]: “AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC (MDC 08)”

MDC crossing · procedures (18508)

  • 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.”
  • 005T0ZZ — Destruction of Spinal Meninges, Open Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T3ZZ — Destruction of Spinal Meninges, Percutaneous Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T4ZZ — Destruction of Spinal Meninges, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Endoscopic Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0Z3 — Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0ZZ — Destruction of Cervical Spinal Cord, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • and 18503 more

Nearest codes (40)

  • M97 — Periprosthetic fracture around internal prosthetic joint [Sibling]
  • M97.11XD — Periprosthetic fracture around internal prosthetic right knee joint, subsequent encounter [Sibling]
  • M97.11XS — Periprosthetic fracture around internal prosthetic right knee joint, sequela [Sibling]
  • M97.12 — Periprosthetic fracture around internal prosthetic left knee joint [Sibling]
  • M97.12XA — Periprosthetic fracture around internal prosthetic left knee joint, initial encounter [Sibling]
  • M97.12XD — Periprosthetic fracture around internal prosthetic left knee joint, subsequent encounter [Sibling]
  • M97.12XS — Periprosthetic fracture around internal prosthetic left knee joint, sequela [Sibling]
  • M97.2 — Periprosthetic fracture around internal prosthetic ankle joint [Sibling]
  • and 32 more

Change history

  • FY2017 — Added to the code set [Change history]

Referenced by Other Codes

Clinical classification (AHRQ CCSR):INJ004 — Fracture of the upper limb, initial encounter (default).

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

Potential MS-DRG Relationships (FY2026)

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.

Official ICD-10-CM tabular notes on other codes that name M97.42XA or its code family.

1 Excludes1 notes: T84.01 (via M97.-).

1 Excludes2 notes: M96 (via M97.-).

Frequently Asked Questions (FAQ) & Clinical Guidance

Does M97.42XA require a 7th character?

Yes. The appropriate 7th character is to be added to each code from category M97.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M97.42XA in its code family, with their registry titles.

  • M97.41 — Periprosthetic fracture around internal prosthetic right elbow joint
  • M97.41XA — Periprosthetic fracture around internal prosthetic right elbow joint, initial encounter
  • M97.41XD — Periprosthetic fracture around internal prosthetic right elbow joint, subsequent encounter
  • M97.41XS — Periprosthetic fracture around internal prosthetic right elbow joint, sequela
  • M97.42 — Periprosthetic fracture around internal prosthetic left elbow joint
  • M97.42XD — Periprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter
  • M97.42XS — Periprosthetic fracture around internal prosthetic left elbow joint, sequela
  • M97.8 — Periprosthetic fracture around other internal prosthetic joint
  • M97.8XXA — Periprosthetic fracture around other internal prosthetic joint, initial encounter
  • M97.8XXD — Periprosthetic fracture around other internal prosthetic joint, subsequent encounter

View all codes in the M97 family