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ICD-10/M97.9XXS

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

Official Registry Overview & Definition

Periprosthetic fracture around unspecified internal prosthetic joint, sequela is a billable ICD-10-CM diagnosis code (M97.9S).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for M97.9XXS 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 unspecified internal prosthetic joint, sequela
    FY2017 changes

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 M97.9XXS 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)

  • INJ073 — Injury, sequela [CCSR]

Potential MS-DRG

  • DRG 922 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC [MS-DRG]: “OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC (MDC 21)”
  • DRG 923 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC [MS-DRG]: “OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC (MDC 21)”

MDC crossing · procedures (32029)

  • MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs [MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — 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.”
  • 0016070 — Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016071 — Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016072 — Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016073 — Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016074 — Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • and 32024 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):INJ073 — Injury, sequela (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)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 2 MS-DRGs: DRG 922 (MDC 21), DRG 923 (MDC 21).

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 M97.9XXS or its code family.

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

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

Frequently Asked Questions (FAQ) & Clinical Guidance

Does M97.9XXS 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 M97.9XXS in its code family, with their registry titles.

  • 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
  • M97.42XS — 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
  • M97.8XXS — Periprosthetic fracture around other internal prosthetic joint, sequela
  • M97.9 — Periprosthetic fracture around unspecified internal prosthetic joint
  • M97.9XXA — Periprosthetic fracture around unspecified internal prosthetic joint, initial encounter

View all codes in the M97 family