M97.42XS ICD-10-CM Code: Periprosthetic fracture around internal prosthetic left elbow joint, sequela
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 (FY2026), Appendix B.
- MS-DRG 922 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC (MDC 21)
- MS-DRG 923 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC (MDC 21)
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.
Code Set: Valid FY2026 and FY2027. FY2026 took effect October 1, 2025.
Official Registry Overview & Definition
Official Tabular Instructional Notes
Sequencing, inclusion, and exclusion notes published for M97.42XS 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.
- fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-)
- breakage (fracture) of prosthetic joint (T84.01-)
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
Frequently Asked Questions (FAQ) & Clinical Guidance
Does M97.42XS 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 M97.42XS in its code family, with their registry titles.
- 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
- M97.42XA — Periprosthetic fracture around internal prosthetic left elbow joint, initial encounter
- M97.42XD — Periprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter
- 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
- M97.8XXS — Periprosthetic fracture around other internal prosthetic joint, sequela
- M97.9 — Periprosthetic fracture around unspecified internal prosthetic joint