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.
Periprosthetic fractures occur as a result of trauma or pathological conditions. A code for any underlying condition as well as a code for the specific type of fracture (traumatic or pathological) should also be assigned. If the reason for admission/encounter is the fracture, the specific type of fracture (traumatic or pathological) should be sequenced first and the periprosthetic fracture code should be sequenced as a secondary diagnosis code. These fractures can occur around any prosthesis, but the most common sites are the hip (M97.0), knee (M97.1), ankle (M97.2), shoulder (M97.3), elbow (M97.4). Subcategory M97.8 identifies “other” sites of periprosthetic fractures. These codes require a fifth character to specify laterality for each joint and also require a 7th character to indicate: initial encounter (A), subsequent encounter (D) or sequela (S).
A 64-year-old female patient with history of bilateral hip replacement presented to the hospital after having tripped and fallen sustaining a traumatic periprosthetic fracture of the lower end of the right femur. She had no symptoms of loosening of the prosthesis prior to this fall. How is this coded?
A patient, who is status post right total hip replacement, presents with a periprosthetic fracture. Patient states he stepped off of a curb, and immediately felt pain in the hip. After study, it was determined that the patient had a pathological fracture of the pelvis. How is this coded?