2027 ICD-10-CM Diagnosis Code M97.9XXAPeriprosthetic fracture around unspecified internal prosthetic joint, initial encounter
ICD-10-CM Codes›M00–M99›M97›M97
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- 7th Character A — Initial Encounter
M97.9XXA 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 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the lower limb (except hip), initial encounter.
Code Identity
Code Classification
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to M97.9XXA: 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 M97.9XXA, its category, or a range that includes it.
Excludes1 1
These codes carry an Excludes1 note naming M97.9XXA: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 1
These codes carry an Excludes2 note naming M97.9XXA: its condition is not part of those codes, and both may be reported when the patient has both.
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 M97.9XXA to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code History & ChangesHistory
Replacement M97.9XXA replaces the following previously assigned code(s):
- T84.049A - Periprosth fracture around unsp internal prosth joint, init
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, 2026 through September 30, 2027.
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, 561, 560, with relative weights from 0.8258 to 1.8087 depending on complications. Higher weights mean higher Medicare reimbursement.
Is M97.9XXA a CC or MCC?
CMS lists M97.9XXA 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 M97.9XXA?
The Code First note at M97, which applies to M97.9XXA, reads: if known, the specific type and cause of fracture, such as traumatic or pathological. When one of these applies, it is sequenced before M97.9XXA.
