There are different coding guidelines for coding all sort of fractures. Earlier we have seen how we can code the non-traumatic or pathological fractures. Similarly, today we try to learn about coding Periprosthetic fractures.
There is a set of category (M97) codes used only for coding Periprosthetic fractures. This category of codes are present in Chapter 13, Diseases of the musculoskeletal system and connective tissue.
Earlier the Periprosthetic fractures were classified in the complication section of codes of sub-category T84.04, Periprosthetic fracture around internal prosthetic joint. Before we move ahead, let us first know more about fracture coding.
Coding guidelines for Initial, Subsequent Encounter and Sequela ICD 10 code
Coding guide for Sequela Encounter ICD 10 codes
Superb tips for coding Subsequent encounter in Fracture coding
What are Periprosthetic fractures?
A fracture normally occurs from a trauma or an injury. Same way a Periprosthetic fracture occurs as a result of an injury or pathological conditions. Hence to code periprosthetic fracture, we have to use two ICD 10 codes, one for the underlying condition and other for the specific type of fracture (traumatic or pathological)
So, next time if you come across a Periprosthetic fracture as reason for admission/encounter, then assign the specific type of fracture (traumatic or pathological) as primary diagnosis and the periprosthetic fracture code should be sequenced as a secondary diagnosis code.
The Periprosthetic fractures occur around any prosthesis. Since, all these are fracture codes, each of these codes requires to be specific with laterality for joints. Also, the fracture diagnosis codes should have 7th character to indicate the initial encounter (A), subsequent encounter (D) or Sequela(S). Below are few examples of Periprosthetic codes for different joints.
Hip (M97.0)
Knee (M97.1)
Ankle (M97.2)
Shoulder (M97.3)
Elbow (M97.4)
Subcategory M97.8 – “other” sites of periprosthetic fractures
If a patient with a history of bilateral hip replacement and comes to a physician for a traumatic periprosthetic fracture of the lower end of the right femur, then this scenario should be reported as below.
Primary diagnosis
S72.401A, Unspecified fracture of lower end of right femur, initial encounter for closed fracture
Secondary diagnosis
M97.01XA, Periprosthetic fracture around internal prosthetic right hip joint, initial encounter