M96.669 — Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified leg
Is M96.669 billable?
Yes, but M96.669 will trip a Medicare edit. M96.669 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists M96.669 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
M96.669 at a glance
| Code | M96.669 |
|---|---|
| Description | Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified leg |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to M96.669?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name M96.669 directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does M96.669 group to?
M96.669 sits in MDC 08 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 559Aftercare, Musculoskeletal System and Connective Tissue with MCCmedical
- 560Aftercare, Musculoskeletal System and Connective Tissue with CCmedical
- 561Aftercare, Musculoskeletal System and Connective Tissue without CC/MCCmedical
As a secondary diagnosis, M96.669 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M96.669 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M96.66, the nearest indexed parent of M96.669. Use them to find the family, then select the specific code.
- Fracture, traumatic › femur, femoral › following insertion of implant, prosthesis or plate (abduction) (adduction) (separation)
- Fracture, traumatic › following insertionof orthopedic implant, joint prosthesis or bone plate › femur (abduction) (adduction) (separation)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M96.669, but a patient may have both at the same time. When documentation supports it, M96.669 and the excluded code may both be reported.
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Excludes2 — not included here — inherited from M96
The conditions below are not part of M96.669, but a patient may have both at the same time. When documentation supports it, M96.669 and the excluded code may both be reported.
Excludes2 — not included here — inherited from M96.6
The conditions below are not part of M96.669, but a patient may have both at the same time. When documentation supports it, M96.669 and the excluded code may both be reported.
- complication of internal orthopedic devices, implants or grafts (T84.-)
How long has M96.669 existed?
M96.669 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.