M97.9XXS — Periprosthetic fracture around unspecified internal prosthetic joint, sequela
Is M97.9XXS billable?
Yes, but M97.9XXS is an unspecified code. M97.9XXS is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, M97.9XXS 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 M97.9XXS — the more specific alternatives are listed below.
More specific alternatives
- M97.01XSPeriprosthetic fracture around internal prosthetic right hip joint, sequela
- M97.11XSPeriprosthetic fracture around internal prosthetic right knee joint, sequela
- M97.21XSPeriprosthetic fracture around internal prosthetic right ankle joint, sequela
- M97.31XSPeriprosthetic fracture around internal prosthetic right shoulder joint, sequela
- M97.41XSPeriprosthetic fracture around internal prosthetic right elbow joint, sequela
- M97.8XXSPeriprosthetic fracture around other internal prosthetic joint, sequela
M97.9XXS at a glance
| Code | M97.9XXS |
|---|---|
| Description | Periprosthetic fracture around unspecified internal prosthetic joint, sequela |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "S" | sequela |
What does the 7th character "S" mean in M97.9XXS?
In M97.9XXS, the 7th character S means sequela. The 7th character is required for M97.9XXS to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
Which MS-DRGs does M97.9XXS group to?
M97.9XXS sits in MDC 21 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 922Other Injury, Poisoning and Toxic Effect Diagnoses with MCCmedical
- 923Other Injury, Poisoning and Toxic Effect Diagnoses without MCCmedical
How is M97.9XXS listed in the Alphabetic Index?
The Alphabetic Index lists these routes under M97.9, the nearest indexed parent of M97.9XXS. 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 M97.9XXS. M97.9XXS 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 M97.9XXS, but a patient may have both at the same time. When documentation supports it, M97.9XXS 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 M97.9XXS, but a patient may have both at the same time. When documentation supports it, M97.9XXS and the excluded code may both be reported.
How long has M97.9XXS existed?
M97.9XXS 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.