M97

Header — not billable

Periprosthetic fracture around internal prosthetic joint

The ICD-10 code for periprosthetic fracture around internal prosthetic joint is M97.

M97 is a non-billable header code. It groups related conditions but cannot be used on its own for reimbursement — select one of the 7 more specific codes below.

Clinical notes

Code first

This code represents a manifestation of an underlying disease. Coding convention requires the underlying (etiology) code to be sequenced first, with this code listed second.

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

Excludes2 (not included here)

An Excludes2 note means the excluded condition is not part of this one, but a patient can have both at the same time — in that case both codes 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-)

7th character definitions

These definitions specify what each valid 7th-character value means for codes in this category.

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7th character note

This category requires a 7th character to indicate additional clinical detail (e.g. encounter type: initial, subsequent, sequela). The code is incomplete without it.

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

Documentation support

General coding-documentation guidance — not a substitute for payer-specific requirements or professional coding judgment.

•This is a non-billable header code. Documentation must support a more specific child code before this diagnosis can be reported on a claim.
•This code represents a manifestation. Documentation should identify the underlying condition, which must be coded first.
•This category requires a 7th character. Documentation should clearly indicate the episode of care (initial encounter, subsequent encounter, or sequela).
•As a general rule, code to the highest level of specificity supported by the documentation in the medical record.