2026 ICD-10-CM Diagnosis Code M97.9XXAPeriprosthetic fracture around unspecified internal prosthetic joint, initial encounter

ICD-10-CM Codes›M00–M99›M97›M97

ICD-10-CM M97.9XXA
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

M97.9XXA is a billable ICD-10-CM diagnosis code for periprosthetic fracture around unspecified internal prosthetic 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the lower limb (except hip), initial encounter.

Code Identity

ICD-10-CM Code
M97.9XXA
Billable Status
Yes — Valid for Submission
Code Describes
Periprosthetic fracture around unspecified internal prosthetic joint, initial encounter
Short Description
Periprosth fracture around unsp internal prosth joint, init
Parent Code
M97.9
Periprosthetic fracture around unspecified internal prosthetic 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 CodeM97.9XXAPeriprosthetic fracture around unspecified internal prosthetic joint, initial encounter

Clinical ClassificationClinical

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

CCSR INJ005
Fracture of the lower limb (except hip), initial 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 M97.9XXA to ICD-9-CMHistory

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

ICD-9-CM
996.44 Periprosthetc fx-pros jt
Approximate The match is approximate rather than exact.

Code History & ChangesHistory

Replacement M97.9XXA replaces the following previously assigned code(s):

  • T84.049A - Periprosth fracture around unsp internal prosth joint, init
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 M97.9XXAOverview

Is M97.9XXA a billable code?

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

What does the 7th character A in M97.9XXA mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for periprosthetic fracture around unspecified internal prosthetic joint, such as an emergency visit or first evaluation.

What MS-DRG does M97.9XXA group to?

When periprosthetic fracture around unspecified internal prosthetic 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 M97.9XXA?

Under the General Equivalence Mappings, periprosthetic fracture around unspecified internal prosthetic 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.