Ask Proactive – How do I appropriately code a periprosthetic fracture? Should I use an M or S ICD-10 code?

How do I appropriately code a periprosthetic fracture? Should I use an M or S ICD-10 code?

A:

Fractures result from trauma or injury or a pathological condition.  With a periprosthetic fracture, two ICD-10 codes would be utilized.  One code would include the underlying condition and the other would include the specific type of fracture whether pathological or traumatic.  Therefore, the primary diagnosis for a traumatic periprosthetic fracture would be the specific type of fracture whether traumatic or pathological and then the periprosthetic fracture code would be the secondary diagnosis code.

Examples:

1. K has a left hip replacement with a closed nondisplaced traumatic periprosthetic fracture of the base of left femur.

 Primary diagnosis: S72.045D, Nondisplaced fracture of base of neck of left femur, subsequent encounter for closed fracture with routine healing

Secondary diagnosis: M97.02, Periprosthetic fracture around internal prosthetic left hip joint

2. J has a right shoulder replacement and now admitted to the SNF for periprosthetic fracture of the humerus. The fracture was caused by osteoporosis.

Primary diagnosis: M84.421D, Pathological fracture, right humerus, subsequent encounter for fracture with routine healing

Secondary diagnosis: M97.31XD, Periprosthetic fracture around internal prosthetic right shoulder joint, subsequent encounter

Resource

1. Centers for Medicare & Medicaid Services. (2020, December 16). ICD-10-CM Official Guidelines for Coding and Reporting FY 2021.  https://www.cms.gov/medicare/icd-10/2021-icd-10-cm