2027 ICD-10-CM Diagnosis Code M97.01XDPeriprosthetic fracture around internal prosthetic right hip joint, subsequent encounter
M97.01XD is a billable ICD-10-CM diagnosis code for periprosthetic fracture around internal prosthetic right hip joint, subsequent encounter. The 7th character D marks it as a subsequent encounter code, used during routine care in the healing or recovery phase. 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. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the neck of the femur (hip), subsequent encounter.
Code Identity
Code Classification
Present on Admission (POA)Billing
M97.01XD is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Periprosthetic fracture around internal prosthetic joint (M97).
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M97.01XD: its own notes plus those printed at M97 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.
- 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)
Code First
The underlying condition named in the note is sequenced before this code.
- if known, the specific type and cause of fracture, such as traumatic or pathological
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
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- The appropriate 7th character is to be added to each code from category M97
- Ainitial encounter
- Dsubsequent encounter this code
- Ssequela
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name M97.01XD, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming M97.01XD: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 2
These codes carry an Excludes2 note naming M97.01XD: its condition is not part of those codes, and both may be reported when the patient has both.
- M96 Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classifiedperiprosthetic fracture around internal prosthetic joint (M97.-) names M97.-, which includes this code
- S72 Fracture of femurperiprosthetic fracture of prosthetic implant of hip (M97.0-) names M97.0-, 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 M97.01XD to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement M97.01XD replaces the following previously assigned code(s):
- T84.040D - Periprosth fracture around internal prosth r hip jt, subs
Questions About M97.01XDOverview
Is M97.01XD a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report periprosthetic fracture around internal prosthetic right hip joint, subsequent encounter on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character D in M97.01XD mean?
The final character D marks a subsequent encounter: use it for routine care while the periprosthetic fracture around internal prosthetic right hip joint is healing, after active treatment has ended.
What MS-DRG does M97.01XD group to?
When periprosthetic fracture around internal prosthetic right hip joint, subsequent encounter 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 M97.01XD exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for periprosthetic fracture around internal prosthetic right hip joint, subsequent encounter on inpatient claims. The code appears in the Periprosthetic fracture around internal prosthetic joint (M97) range of the CMS exempt list.
What is coded first with M97.01XD?
The Code First note at M97, which applies to M97.01XD, reads: if known, the specific type and cause of fracture, such as traumatic or pathological. When one of these applies, it is sequenced before M97.01XD.
