2027 ICD-10-CM Diagnosis Code M96.639Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm
ICD-10-CM Codes›M00–M99›M96›M96
- Billable — Valid for Submission
- CC — Complication or Comorbidity
M96.639 is a billable ICD-10-CM diagnosis code for fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 559 through 561. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 193 closely related codes. The code is flagged as an unspecified code, since codes identifying laterality exist in the same family. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Postprocedural or postoperative musculoskeletal system complication.
M96.639 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 176 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 176, ESRD (V21) category 176, and ESRD (V24) category 176 for payment year 2027.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for M96.639.
Medicare Risk Adjustment (HCC)Billing
M96.639 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M96.639: its own notes plus those printed at M96.6, M96, and Chapter 13. A note printed at a category, block or chapter applies to every code under it.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- complication of internal orthopedic devices, implants or grafts (T84.-)
- 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)
Notes
General instructions on how these codes are used.
- Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M96.639, its category, or a range that includes it.
Excludes1 3
These codes carry an Excludes1 note naming M96.639: they are not reported together with it, unless the two conditions are unrelated.
- M40 Kyphosis and lordosispostprocedural kyphosis and lordosis (M96.-) names M96.-, which includes this code
- Block M86-M90 Other osteopathiespostprocedural osteopathies (M96.-) names M96.-, which includes this code
- Block M91-M94 Chondropathiespostprocedural chondropathies (M96.-) names M96.-, which includes this code
Excludes2 5
These codes carry an Excludes2 note naming M96.639: its condition is not part of those codes, and both may be reported when the patient has both.
- M95 Other acquired deformities of musculoskeletal system and connective tissuepostprocedural musculoskeletal disorders (M96.-) names M96.-, which includes this code
- M97 Periprosthetic fracture around internal prosthetic jointfracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-) names M96.6-, which includes this code
- Block T80-T88 Complications of surgical and medical care, not elsewhere classifiedintraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-) names M96.-, which includes this code
- T81 Complications of procedures, not elsewhere classifiedintraoperative and postprocedural complications of specific body system (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95, K91.-, L76.-, M96.-, N99.-) names M96.-, which includes this code
- T84 Complications of internal orthopedic prosthetic devices, implants and graftsfracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6) names M96.6, which includes this code
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Fractures
A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.
The full article covers:
- What is a fracture?
- What are the different types of fractures?
- What causes fractures?
- What are the symptoms of a fracture?
- How are fractures diagnosed?
- What are the treatments for fractures?
- Can fractures be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert M96.639 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About M96.639Overview
Is M96.639 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does M96.639 group to?
When fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm is the principal diagnosis on an inpatient stay, it groups to MS-DRG 559, 561, 560, with relative weights from 0.8258 to 1.8087 depending on complications. Higher weights mean higher Medicare reimbursement.
Is M96.639 a CC or MCC?
CMS lists M96.639 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 193 closely related codes in its exclusion list.
What is the ICD-9 equivalent of M96.639?
Under the General Equivalence Mappings, fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm converts to ICD-9-CM 996.49 (mech com orth dev NEC). The mapping is approximate, so confirm the match fits the documentation.
Does M96.639 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. M96.639 mapped to HCC 176 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 176 (Complications of Specified Implanted Device or Graft), ESRD (V21) category 176 (Complications of Specified Implanted Device or Graft), and ESRD (V24) category 176 (Complications of Specified Implanted Device or Graft).
