In the United States, there are about 6.3 million fractures recorded each year, with trauma accounting for the majority of these cases, however there are other reasons as well. A pathological fracture is the result of a sick bone breaking spontaneously. Stress fractures can result from repetitive stress on weight-bearing bones, such as those in the foot and lower leg. Let’s learn more about Periprosthetic Fracture Coding and sequencing.

What is a periprosthetic fracture?

Fractures that happen close to or surrounding a prosthetic joint are known as periprosthetic fractures. Rather than being prosthesis-related issues, they are the result of trauma or illness (pathological). Because they don’t genuinely involve the implant, these fractures aren’t classified as a device problem. Periprosthetic fractures have particular codes in ICD-10-CM.

ICD-10-CM Periprosthetic Fracture Coding and Sequencing:

Periprosthetic fractures of coding and sequences include the following key steps, based on ICD-10-CM guidelines:

1) Recognizing the Correct Diagnosis Code for Periprosthetic Fracture:

M97: – Arrangement of ICD-10-CM codes is utilized for periprosthetic fractures. The entire code is determined by the specific location of the fracture.

M97.01-: Periprosthetic fracture around inside prosthetic right hip joint

M97.02-: Periprosthetic fracture around inside prosthetic cleared out hip joint

M97.11-: Periprosthetic fracture around inner prosthetic right knee joint

M97.12-: Periprosthetic fracture around inner prosthetic cleared out knee joint

2) Fracture Type and Encounter:

ICD-10-CM further recognizes the type of fracture by classifying the encounter:

A: Starting encounter (dynamic treatment).

D: Ensuing encounter.

S: Sequela are conditions or complications that follow a fracture.

3) Fundamental Condition:

The appropriate complication code from Chapter 19 (Complications of Surgical and Medical Care) should also be used to code the periprosthetic break if it is associated with a prosthesis complication, such as mechanical failure or loosening.

4) Injury Coding Procedures:

Periprosthetic fractures are considered complications of therapeutic care and not traumatic fractures. Subsequently, codes from the S00-T88 square (related to traumatic fractures) should not be utilized. Instead, the M97 series is suitable.

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5) Periprosthetic fracture coding and Sequencing Rules:

Principal Determination: Typically, the primary diagnosis will be the periprosthetic fracture itself (e.g., M97.11XA for right knee periprosthetic fracture for introduction encounter). The injury should be treated initially if it is the primary concern and not primarily an additional problem or another medical issue.
Secondary Codes: If there are other conditions being treated (e.g., mechanical complications, contamination, or recuperating issues), these should be coded as auxiliary analysis. Utilize fitting codes from the T84.- arrangement for these complications.
External Cause Codes: If the break was caused by a drop or another outside figure, the outside cause codes from Chapter 20 (V00-Y99) may be doled out to capture the circumstances of the harm.

How Are Periprosthetic Fractures Sequenced and Coded?

Periprosthetic fractures are archived utilizing codes from category M97 in ICD-10-CM. Code to begin with, if known, the particular sort and cause of break, such as traumatic or pathological,”.
When detailing periprosthetic breaks, at least two codes are required, per the “Code to begin with” note. A single code from category M97 is assigned, designating the fracture as periprosthetic and specifying the particular joint (ankle, knee, hip, shoulder, elbow, finger, spine, toe, wrist) as well as the condition’s laterality. To report the precise nature and etiology of the fracture (pathological vs. traumatic), a second code is issued. The code representing the type of fracture is sequenced first, followed by the periprosthetic fracture code, according to the instruction note.

Examples of periprosthetic fracture coding and sequencing:

After going down four steps, the patient is admitted with a fresh periprosthetic fracture at the lower end of the left femur. The joint prosthesis itself is not affected by the fracture. For this instance, the principal/first listed diagnosis should be reported using ICD-10-CM codes S72.402A (Unclear fracture of the lower part of left femur, start encounter for closed fracture) and M97. 12XA (Periprosthetic break close inner prosthetic cleared out knee joint, introductory experience) as the auxiliary.

The patient is now recovering from a left shoulder replacement and has rolled over in bed, resulting in a periprosthetic fracture of the humerus. After the patient was examined, it was discovered that underlying osteoporosis was the cause of the fracture. The actual joint prosthesis was not fractured.

In this instance, the principal/first mentioned diagnosis should be reported using ICD-10-CM codes M84.422A (Pathological fracture, left humerus, initial encounter for fracture) and M97.32XA (Periprosthetic fracture surrounding inner prosthetic left shoulder joint, initial encounter) as the secondary diagnosis. (Include a code for osteoporosis as well).

A fracture of the joint prosthesis itself would be sequenced as the principal/first mentioned diagnosis code and would be classified as an internal joint prosthesis problem.

Conclusion:                                                                                          

It is essential to follow the exact ICD-10-CM guidelines when periprosthetic fractures coding and sequencing to ensure that the specific nature of the encounter as well as its underlying etiology are recorded.