ICD-10 Coding for Periprosthetic Fracture(M97.02XA, S72.402A)
Complete ICD-10-CM coding and documentation guide for Periprosthetic Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Periprosthetic Fracture
M97Primary Range
Periprosthetic fracture around internal prosthetic joint
This range specifically addresses fractures occurring around prosthetic joints, which is the primary focus for periprosthetic fractures.
Fracture of femur
This range includes codes for traumatic fractures of the femur, which may occur around prosthetic joints.
Disorders of continuity of bone
This range includes pathological fractures, which can occur around prosthetic joints due to underlying conditions like osteoporosis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M97.02XA | Periprosthetic fracture around internal prosthetic joint, initial encounter | Use when a fracture is confirmed around a prosthetic joint, with imaging evidence. |
|
| S72.402A | Unspecified fracture of lower end of left femur, initial encounter | Use for traumatic fractures of the femur, including those around prosthetic joints. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for periprosthetic fracture
Essential facts and insights about Periprosthetic Fracture
Primary ICD-10-CM Codes for periprosthetic fracture
Decision Criteria
clinical Criteria
- Fracture confirmed around prosthetic joint with stable prosthesis
Applicable To
- Fracture around hip prosthesis
Excludes
- Mechanical complication of prosthetic joint (T84.0-)
Clinical Validation Requirements
- X-ray or CT confirming fracture line within 5 cm of prosthesis
- Operative note confirming prosthesis stability
Code-Specific Risks
- Misclassification as a mechanical complication
Coding Notes
- Ensure to document the type of fracture and prosthesis stability.
S72.402A - Unspecified fracture of lower end of left femur, initial encounter
Use for traumatic fractures of the femur, including those around prosthetic joints.
Applicable To
- Traumatic fracture of femur
Excludes
- Pathological fracture (M84.4-)
Clinical Validation Requirements
- ED triage note documenting trauma mechanism
- Imaging showing fracture without pathological bone changes
Coding Notes
Ensure to specify laterality and encounter type.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Periprosthetic Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M97.02XA.
Impact
Clinical: Ambiguity in treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always document left/right/bilateral, Use templates with laterality prompts
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with updated ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M97.XXX + fracture code
Impact
Using M97 as primary instead of secondary code.
Mitigation Strategy
Educate coders on correct sequencing rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Periprosthetic Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Periprosthetic Fracture
Use these documentation templates to ensure complete and accurate documentation for Periprosthetic Fracture. These templates include all required elements for proper coding and billing.
Orthopedic H&P for periprosthetic fracture
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Prosthesis details
- Imaging findings
- Assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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