2027 ICD-10-CM Diagnosis Code M97.11XAPeriprosthetic fracture around internal prosthetic right knee joint, initial encounter
ICD-10-CM Codes›M00–M99›M97›M97
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- 7th Character A — Initial Encounter
M97.11XA is a billable ICD-10-CM diagnosis code for periprosthetic fracture around internal prosthetic right knee joint, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. 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. Coders also document this condition as fracture of bone adjacent to knee joint prosthesis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the lower limb (except hip), initial encounter.
Code Identity
Code Classification
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when M97.11XA is part of the patient record.
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older
High Priority: YES
Measure Type: Process
Submission Methods: Claims, Registry
Description: Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication.
Osteoporosis Management in Women Who Had a Fracture
High Priority: NO
Measure Type: Process
Submission Methods: Claims, Registry
Description: The percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the 180 days after the fracture.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Fracture of bone adjacent to knee joint prosthesis
- Fracture of bone adjacent to right knee joint prosthesis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M97.11XA: 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 this code
- Dsubsequent encounter
- 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 M97.11XA, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming M97.11XA: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 2
These codes carry an Excludes2 note naming M97.11XA: 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
- S82 Fracture of lower leg, including ankleperiprosthetic fracture around internal prosthetic implant of knee joint (M97.1-) names M97.1-, 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 M97.11XA to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement M97.11XA replaces the following previously assigned code(s):
- T84.042A - Periprosth fracture around internal prosth r knee jt, init
Questions About M97.11XAOverview
Is M97.11XA a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report periprosthetic fracture around internal prosthetic right knee joint, initial encounter on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character A in M97.11XA mean?
The final character A marks the initial encounter: use it while the patient is receiving active treatment for periprosthetic fracture around internal prosthetic right knee joint, such as an emergency visit or first evaluation.
What MS-DRG does M97.11XA group to?
When periprosthetic fracture around internal prosthetic right knee joint, initial 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 M97.11XA a CC or MCC?
CMS lists M97.11XA 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 coded first with M97.11XA?
The Code First note at M97, which applies to M97.11XA, reads: if known, the specific type and cause of fracture, such as traumatic or pathological. When one of these applies, it is sequenced before M97.11XA.
