Skip to main content

M97.9 ICD-10-CM Code: Periprosthetic fracture around unspecified internal prosthetic joint

Compare with another code for M97.9Check this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
2 Excludes2 · 1 code-first instruction

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

7th character:required: report a code with a 7th character· The appropriate 7th character is to be added to each code from category M97See the 7th character note

Code firstfrom M97Sequence the underlying condition before this code
  • Code first, if known, the specific type and cause of fracture, such as traumatic or pathological
Excludes2from M97Not included here; may be reported together
  • fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-)
  • breakage (fracture) of prosthetic joint (T84.01-)

Where it sits Source: CMS/NCHS

Under:Chapter 13: Diseases of the Musculoskeletal System and Connective TissueM97 Periprosthetic fracture around internal prosthetic joint

Codes under M97.9 (3)

  • M97.9XXAPeriprosthetic fracture around unspecified internal prosthetic joint, initial encounterBillable
  • M97.9XXDPeriprosthetic fracture around unspecified internal prosthetic joint, subsequent encounterBillable
  • M97.9XXSPeriprosthetic fracture around unspecified internal prosthetic joint, sequelaBillable

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M97.9 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on M97.9 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.

Source: inherited from M97

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

Source: inherited from M97

7th Character Guide

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

  • A — initial encounter
  • D — subsequent encounter
  • S — sequela

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

M97.9XXA, M97.9XXD, M97.9XXS

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for M97.9

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

Before you code M97.9

  1. M97.9 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewM97.9XXA, M97.9XXD

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. M97.9 is not valid without one. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

    See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

Choose the right path

  1. Does the documentation support one of the more specific codes beneath M97.9?
    Yes → Select that code and continue the checks below on its own page.
    No → M97.9 cannot be reported as written. Where the codes beneath it include an unspecified code, that code applies when the record goes no further; otherwise query for the missing detail.

    ReviewM97.9XXA, M97.9XXD

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then the code beneath M97.9.
    No → Continue; do not add an underlying condition the record does not document.
  3. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Report the code beneath M97.9 that the documentation supports, not M97.9 itself. Then confirm that code is valid for the date of service on its own page.

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).
Encounter type
Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).
Open or closed; displaced or nondisplaced
Defaults apply when the record is silent: closed, and displaced (Guidelines I.C.19.c).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).
Any detail beyond this code’s title
What the record states that a more specific code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of M97.9(2 notes)

    Coding workflow: The conditions named in this note are not included in M97.9. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareM96.6, T84.01

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

  • Code First — sequencing check(1 note)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before M97.9. Do not add an underlying condition the record does not document.

    See the official tabular notes · Guidelines I.A.13

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).

ReviewM97.2, M97.3, M97.4, M97.8

Documentation: The patient returns during the healing or recovery phase after active treatment of the same condition.

Coding question: Which 7th character applies?

Path: Review the official 7th-character definitions for this family in the 7th Character Guide.

Reason: “Initial encounter” means active treatment, not the first visit; care during recovery takes “subsequent encounter”, and a complication arising from the original condition takes “sequela” (Guidelines I.C.19.a).

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

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.

Don’t confuse M97.9 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of M97.9 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • M97.9XXA— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a initial encounter moves the case to M97.9XXA.

    Full comparison: M97.9 vs M97.9XXA →

  • M97.9XXD— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a subsequent encounter moves the case to M97.9XXD.

    Full comparison: M97.9 vs M97.9XXD →

  • M96.6— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate adds M96.6; it is not part of this code and both may be reported when both are documented.

    Full comparison: M97.9 vs M96.6 →

  • T84.01— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of breakage (fracture) of prosthetic joint adds T84.01; it is not part of this code and both may be reported when both are documented.

    Full comparison: M97.9 vs T84.01 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Periprosthetic fracture around unspecified internal prosthetic joint is a non-billable ICD-10-CM category code (M97.9). A more specific billable subcode must be selected for claims submission.

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

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. Sequencing: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
  3. 2 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name M97.9 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 1 Excludes1 note: T84.01 — Broken internal joint prosthesis (via M97.-).

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

Referenced by 1 Excludes2 note: M96 — Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified (via M97.-).

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

Related Codes

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Fracture, pathological”; these codes share that main term but sit in a different category of the Tabular List.

M84.51 — Pathological fracture in neoplastic disease, shoulder (due to, neoplastic disease NEC, scapula), M84.52 — Pathological fracture in neoplastic disease, humerus (due to, neoplastic disease NEC, humerus), M84.53 — Pathological fracture in neoplastic disease, ulna and radius (due to, neoplastic disease NEC, ulna), M84.54 — Pathological fracture in neoplastic disease, hand (due to, neoplastic disease NEC, carpus), M84.55 — Pathological fracture in neoplastic disease, pelvis and femur (due to, neoplastic disease NEC, femur), M84.550 — Pathological fracture in neoplastic disease, pelvis (due to, neoplastic disease NEC, ilium), M84.559 — Pathological fracture in neoplastic disease, hip, unspecified (due to, neoplastic disease NEC, hip), M84.56 — Pathological fracture in neoplastic disease, tibia and fibula (due to, neoplastic disease NEC, tibia), M84.57 — Pathological fracture in neoplastic disease, ankle and foot (due to, neoplastic disease NEC, toe), M84.58 — Pathological fracture in neoplastic disease, other specified site (due to, neoplastic disease NEC, rib), M84.60 — Pathological fracture in other disease, unspecified site (due to, specified disease NEC), M84.61 — Pathological fracture in other disease, shoulder (due to, specified disease NEC, scapula), M84.62 — Pathological fracture in other disease, humerus (due to, specified disease NEC, humerus), M84.63 — Pathological fracture in other disease, ulna and radius (due to, specified disease NEC, ulna), M84.64 — Pathological fracture in other disease, hand (due to, specified disease NEC, carpus), M84.65 — Pathological fracture in other disease, pelvis and femur (due to, specified disease NEC, hip), M84.650 — Pathological fracture in other disease, pelvis (due to, specified disease NEC, ilium), M84.66 — Pathological fracture in other disease, tibia and fibula (due to, specified disease NEC, tibia), M84.67 — Pathological fracture in other disease, ankle and foot (due to, specified disease NEC, toe), M84.68 — Pathological fracture in other disease, other site (due to, specified disease NEC, rib), +17 more

Contextual Map

Every relationship of M97.9 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 M97.9 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Index entries

  • Fracture, pathological (pathologic), periprosthetic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Fracture, traumatic (abduction) (adduction) (separation), periprosthetic, around internal prosthetic joint[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (40)

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Common coding questions

MedCoder editorial

Can M97.9 be billed directly?

No. M97.9 (Periprosthetic fracture around unspecified internal prosthetic joint) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does M97.9 require a 7th character?

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

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "M97.9 — Periprosthetic fracture around unspecified internal prosthetic joint." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/m97.9-periprosthetic-fracture-around-unspecified-internal-prosthetic-joint

Change history

  • FY2017 — October 1, 2016
    Added to the code set
    Periprosthetic fracture around unspecified internal prosthetic joint
    FY2017 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M97.9 in its code family, with their registry titles.

View all codes in the M97 family