2026 ICD-10-CM Diagnosis Code M97.42XDPeriprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter

ICD-10-CM Codes›M00–M99›M97›M97

ICD-10-CM M97.42XD
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

M97.42XD is a billable ICD-10-CM diagnosis code for periprosthetic fracture around internal prosthetic left elbow 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 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 559 through 561. The code is exempt from POA reporting. Coders also document this condition as fracture of bone adjacent to elbow prosthesis. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the upper limb, subsequent encounter.

Code Identity

ICD-10-CM Code
M97.42XD
Billable Status
Yes — Valid for Submission
Code Describes
Periprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter
Short Description
Periprosth fx around internal prosth l elbow joint, subs
Parent Code
M97.42
Periprosthetic fracture around internal prosthetic left elbow joint

Code Classification

ChapterM00–M99Diseases of the musculoskeletal system and connective tissue
SectionM97Periprosthetic fracture around internal prosthetic joint
CategoryM97Periprosthetic fracture around internal prosthetic joint
This CodeM97.42XDPeriprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter

Present on Admission (POA)Billing

M97.42XD is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Fracture of bone adjacent to elbow prosthesis
  • Fracture of bone adjacent to left elbow joint prosthesis

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR INJ041
Fracture of the upper limb, subsequent encounter
Default principal diagnosis: inpatient Yes · outpatient Yes

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 M97.42XD to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
V54.29 Aftrcre path fx bone NEC
Approximate The match is approximate rather than exact.

Code History & ChangesHistory

Replacement M97.42XD replaces the following previously assigned code(s):

  • T84.048D - Periprosth fracture around oth internal prosth joint, subs
FY 2018AddedAdded to the ICD-10-CM code setEffective October 1, 2017.
FY 2019–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About M97.42XDOverview

Is M97.42XD a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report periprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character D in M97.42XD mean?

The final character D marks a subsequent encounter: use it for routine care while the periprosthetic fracture around internal prosthetic left elbow joint is healing, after active treatment has ended.

What MS-DRG does M97.42XD group to?

When periprosthetic fracture around internal prosthetic left elbow joint, subsequent 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.

Is M97.42XD 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 left elbow joint, subsequent encounter on inpatient claims.

What is the ICD-9 equivalent of M97.42XD?

Under the General Equivalence Mappings, periprosthetic fracture around internal prosthetic left elbow joint, subsequent encounter converts to ICD-9-CM V54.29 (aftrcre path fx bone NEC). The mapping is approximate, so confirm the match fits the documentation.