AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2016 Issue 4; ICD-10-CM NEW/REVISED CODES
Periprosthetic Fractures
New codes have been created to identify periprosthetic fractures. A new category (M97) has been created in Chapter 13, Diseases of the musculoskeletal system and connective tissue. Periprosthetic fractures were previously classified in the complication section of ICD-10-CM at sub-subcategory T84.04, Periprosthetic fracture around internal prosthetic joint. However, the American Academy of Orthopaedic Surgeons (AAOS) clarified that periprosthetic fractures are not complications of the prosthesis (the prosthesis itself is not fractured, the area around the prosthesis is fractured). For breakage (fracture) of prosthetic joints, assign codes from subcategory T84.01, Broken internal joint prosthesis. ...
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Article Overview
This article reviews how periprosthetic fractures are categorized in ICD-10-CM, including the newer fracture category and related updates involving joint prosthesis complications. It is aimed at coders, auditors, and clinical documentation staff who need to understand where these fractures belong, what general sequencing considerations apply, and how the guidance differs from prosthesis breakage. The article also includes a brief coding example and identifies the broad fracture-related coding elements involved.
Why This Topic Matters
Periprosthetic fracture coding changed with the creation of a dedicated ICD-10-CM category, so accurate classification depends on recognizing the correct fracture family and the related coding context. This matters for documentation quality, diagnosis reporting, and consistent code selection across orthopedic encounters.
What You Will Learn
- How periprosthetic fractures are categorized in ICD-10-CM
- How the fracture category relates to joint prosthesis complication coding
- What general documentation elements are involved in these fracture cases
- How a coding example illustrates the topic at a high level
Who Should Read This
- Medical coders
- Coding auditors
- Orthopedic documentation staff
- Revenue cycle professionals
Codes Discussed
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