M97.9XXA — Periprosthetic fracture around unspecified internal prosthetic joint, initial encounter
Is M97.9XXA billable?
Yes, but M97.9XXA is an unspecified code. M97.9XXA is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, M97.9XXA is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting M97.9XXA — the more specific alternatives are listed below.
More specific alternatives
- M97.01XAPeriprosthetic fracture around internal prosthetic right hip joint, initial encounter
- M97.11XAPeriprosthetic fracture around internal prosthetic right knee joint, initial encounter
- M97.21XAPeriprosthetic fracture around internal prosthetic right ankle joint, initial encounter
- M97.31XAPeriprosthetic fracture around internal prosthetic right shoulder joint, initial encounter
- M97.41XAPeriprosthetic fracture around internal prosthetic right elbow joint, initial encounter
- M97.8XXAPeriprosthetic fracture around other internal prosthetic joint, initial encounter
M97.9XXA at a glance
| Code | M97.9XXA |
|---|---|
| Description | Periprosthetic fracture around unspecified internal prosthetic joint, initial encounter |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter |
What does the 7th character "A" mean in M97.9XXA?
In M97.9XXA, the 7th character A means initial encounter. The 7th character is required for M97.9XXA to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
Which MS-DRGs does M97.9XXA group to?
M97.9XXA 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, M97.9XXA is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M97.9XXA listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M97.9, the nearest indexed parent of M97.9XXA. Use them to find the family, then select the specific code.
- Fracture, pathological › periprosthetic (pathologic)
- Fracture, traumatic › periprosthetic, around internal prosthetic joint (abduction) (adduction) (separation)
Code first — inherited from M97
The underlying condition below must be sequenced before M97.9XXA. M97.9XXA describes a manifestation and cannot be the principal or first-listed diagnosis.
- , if known, the specific type and cause of fracture, such as traumatic or pathological
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M97.9XXA, but a patient may have both at the same time. When documentation supports it, M97.9XXA 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 M97
The conditions below are not part of M97.9XXA, but a patient may have both at the same time. When documentation supports it, M97.9XXA and the excluded code may both be reported.
How long has M97.9XXA existed?
M97.9XXA first appears in FY2018 (FY2017 is not available, so it may have appeared then).
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.