2026 ICD-10-CM Diagnosis Code M97.31XAPeriprosthetic fracture around internal prosthetic right shoulder joint, initial encounter
M97.31XA is a billable ICD-10-CM diagnosis code for periprosthetic fracture around internal prosthetic right shoulder 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 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 559 through 561. Coders also document this condition as fracture of bone adjacent to right shoulder joint prosthesis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the upper limb, initial encounter.
Code Identity
Code Classification
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when M97.31XA 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 six months after the fracture.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Fracture of bone adjacent to right shoulder joint prosthesis
- Fracture of bone adjacent to shoulder joint prosthesis
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 M97.31XA to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement M97.31XA replaces the following previously assigned code(s):
- T84.048A - Periprosth fracture around oth internal prosth joint, init
Questions About M97.31XAOverview
Is M97.31XA a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report periprosthetic fracture around internal prosthetic right shoulder joint, initial encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character A in M97.31XA 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 shoulder joint, such as an emergency visit or first evaluation.
What MS-DRG does M97.31XA group to?
When periprosthetic fracture around internal prosthetic right shoulder joint, initial encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 559, 560, 561, with relative weights from 0.8039 to 1.8649 depending on complications. Higher weights mean higher Medicare reimbursement.
What is the ICD-9 equivalent of M97.31XA?
Under the General Equivalence Mappings, periprosthetic fracture around internal prosthetic right shoulder joint, initial encounter converts to ICD-9-CM 996.44 (periprosthetc fx-pros jt). The mapping is approximate, so confirm the match fits the documentation.
