Aug 15, 2022
What is a Periprosthetic Fracture?
Periprosthetic fractures are fractures that occur around a prosthesis. They are not complications of the prosthesis but are caused by either trauma or disease (pathological). These fractures are not coded as a complication since they do not actually involve the implant. ICD-10-CM has specific codes for periprosthetic fractures.
How is a Periprosthetic Fracture Coded and Sequenced?
Periprosthetic fractures are coded within Chapter 13 of ICD-10-CM in category M97. A minimum of two codes are required when reporting the periprosthetic fractures. One code for the periprosthetic fracture and another for the type of fracture, such as traumatic vs. pathological with the underlying condition. If the reason for admission/encounter is for the fracture, then the fracture would be sequenced first and then the periprosthetic fracture code as a secondary diagnosis code.
- Patient is admitted for new periprosthetic fracture of the lower end of the left femur after falling down 4 steps. This fracture is documented to not involve the actual joint prosthesis. In this case, report ICD-10-CM codes S72.402A (Unspecified fracture of lower end of left femur, initial encounter for closed fracture) as the principal/first listed diagnosis followed by M97.02XA (Periprosthetic fracture around internal prosthetic left hip joint, initial encounter) as a secondary diagnosis. (Also assign external cause codes)
- Patient is status post left shoulder replacement and presents for periprosthetic fracture of the humerus after rolling over in the bed. The patient was worked up and it was found that the fracture was due to underlying osteoporosis. There was no fracture of the actual joint prosthesis. In this case, report ICD-10 CM codes M84.422A (Pathological fracture, left humerus, initial encounter for fracture) as the principal/first listed diagnosis followed by M97.32XA (Periprosthetic fracture around internal prosthetic left shoulder joint, initial encounter) as a secondary diagnosis. (Also assign osteoporosis and external cause codes)
If the actual joint prosthesis is broken, then the fracture would be coded as a complication of internal joint prosthesis and sequenced as the principal/first listed diagnosis code.
I-10 Coding Handbook
ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2016 Page: 42
ICD-10-CM/PCS Coding Clinic, First Quarter ICD-10 2018 Page: 21
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