ICD-10 · PDGM grouping
M97 Periprosthetic fracture around internal prosthetic joint
All 36 codes in the M97 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
ICD-10-CM FY2027 · CMS grouper v07.2.26
Codes in family
36
Can lead a claim
33
Cannot lead a claim
3
What CMS assigns to M97
33 of the 36 codes group to Musculoskeletal Rehabilitation; 3 are assigned no clinical group. None of the 36 is assigned a comorbidity subgroup. 33 of the 36 can lead a claim. CMS attaches a code-first note to all 36.
Code first
CMS grouper convention 12, on all 36 codes. Code first:
- underlying disease
Every code in M97
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| M97.0 Periprosthetic fracture around internal prosthetic hip joint | ||||
| M97.01 Periprosthetic fracture around internal prosthetic right hip joint | ||||
| M97.01XA | Periprosthetic fracture around internal prosthetic right hip joint, initial encounterCMS: Periprosth fracture around internal prosth r hip jt, init | Can lead a claim, code first applies | E | None |
| M97.01XD | Periprosthetic fracture around internal prosthetic right hip joint, subsequent encounterCMS: Periprosth fracture around internal prosth r hip jt, subs | Can lead a claim, code first applies | E | None |
| M97.01XS | Periprosthetic fracture around internal prosthetic right hip joint, sequelaCMS: Periprosth fracture around internal prosth r hip jt, sequela | Can lead a claim, code first applies | E | None |
| M97.02 Periprosthetic fracture around internal prosthetic left hip joint | ||||
| M97.02XA | Periprosthetic fracture around internal prosthetic left hip joint, initial encounterCMS: Periprosth fracture around internal prosth l hip jt, init | Can lead a claim, code first applies | E | None |
| M97.02XD | Periprosthetic fracture around internal prosthetic left hip joint, subsequent encounterCMS: Periprosth fracture around internal prosth l hip jt, subs | Can lead a claim, code first applies | E | None |
| M97.02XS | Periprosthetic fracture around internal prosthetic left hip joint, sequelaCMS: Periprosth fracture around internal prosth l hip jt, sequela | Can lead a claim, code first applies | E | None |
| M97.1 Periprosthetic fracture around internal prosthetic knee joint | ||||
| M97.11 Periprosthetic fracture around internal prosthetic right knee joint | ||||
| M97.11XA | Periprosthetic fracture around internal prosthetic right knee joint, initial encounterCMS: Periprosth fracture around internal prosth r knee jt, init | Can lead a claim, code first applies | E | None |
| M97.11XD | Periprosthetic fracture around internal prosthetic right knee joint, subsequent encounterCMS: Periprosth fracture around internal prosth r knee jt, subs | Can lead a claim, code first applies | E | None |
| M97.11XS | Periprosthetic fracture around internal prosthetic right knee joint, sequelaCMS: Periprosth fx around internal prosth r knee jt, sequela | Can lead a claim, code first applies | E | None |
| M97.12 Periprosthetic fracture around internal prosthetic left knee joint | ||||
| M97.12XA | Periprosthetic fracture around internal prosthetic left knee joint, initial encounterCMS: Periprosth fracture around internal prosth l knee jt, init | Can lead a claim, code first applies | E | None |
| M97.12XD | Periprosthetic fracture around internal prosthetic left knee joint, subsequent encounterCMS: Periprosth fracture around internal prosth l knee jt, subs | Can lead a claim, code first applies | E | None |
| M97.12XS | Periprosthetic fracture around internal prosthetic left knee joint, sequelaCMS: Periprosth fx around internal prosth l knee jt, sequela | Can lead a claim, code first applies | E | None |
| M97.2 Periprosthetic fracture around internal prosthetic ankle joint | ||||
| M97.21 Periprosthetic fracture around internal prosthetic right ankle joint | ||||
| M97.21XA | Periprosthetic fracture around internal prosthetic right ankle joint, initial encounterCMS: Periprosth fx around internal prosth r ankle joint, init | Can lead a claim, code first applies | E | None |
| M97.21XD | Periprosthetic fracture around internal prosthetic right ankle joint, subsequent encounterCMS: Periprosth fx around internal prosth r ankle joint, subs | Can lead a claim, code first applies | E | None |
| M97.21XS | Periprosthetic fracture around internal prosthetic right ankle joint, sequelaCMS: Periprosth fx around internal prosth r ankle joint, sequela | Can lead a claim, code first applies | E | None |
| M97.22 Periprosthetic fracture around internal prosthetic left ankle joint | ||||
| M97.22XA | Periprosthetic fracture around internal prosthetic left ankle joint, initial encounterCMS: Periprosth fx around internal prosth l ankle joint, init | Can lead a claim, code first applies | E | None |
| M97.22XD | Periprosthetic fracture around internal prosthetic left ankle joint, subsequent encounterCMS: Periprosth fx around internal prosth l ankle joint, subs | Can lead a claim, code first applies | E | None |
| M97.22XS | Periprosthetic fracture around internal prosthetic left ankle joint, sequelaCMS: Periprosth fx around internal prosth l ankle joint, sequela | Can lead a claim, code first applies | E | None |
| M97.3 Periprosthetic fracture around internal prosthetic shoulder joint | ||||
| M97.31 Periprosthetic fracture around internal prosthetic right shoulder joint | ||||
| M97.31XA | Periprosthetic fracture around internal prosthetic right shoulder joint, initial encounterCMS: Periprosth fx around internal prosth r shoulder jt, init | Can lead a claim, code first applies | E | None |
| M97.31XD | Periprosthetic fracture around internal prosthetic right shoulder joint, subsequent encounterCMS: Periprosth fx around internal prosth r shoulder jt, subs | Can lead a claim, code first applies | E | None |
| M97.31XS | Periprosthetic fracture around internal prosthetic right shoulder joint, sequelaCMS: Periprosth fx around internal prosth r shoulder jt, sequela | Can lead a claim, code first applies | E | None |
| M97.32 Periprosthetic fracture around internal prosthetic left shoulder joint | ||||
| M97.32XA | Periprosthetic fracture around internal prosthetic left shoulder joint, initial encounterCMS: Periprosth fx around internal prosth l shoulder jt, init | Can lead a claim, code first applies | E | None |
| M97.32XD | Periprosthetic fracture around internal prosthetic left shoulder joint, subsequent encounterCMS: Periprosth fx around internal prosth l shoulder jt, subs | Can lead a claim, code first applies | E | None |
| M97.32XS | Periprosthetic fracture around internal prosthetic left shoulder joint, sequelaCMS: Periprosth fx around internal prosth l shoulder jt, sequela | Can lead a claim, code first applies | E | None |
| M97.4 Periprosthetic fracture around internal prosthetic elbow joint | ||||
| M97.41 Periprosthetic fracture around internal prosthetic right elbow joint | ||||
| M97.41XA | Periprosthetic fracture around internal prosthetic right elbow joint, initial encounterCMS: Periprosth fx around internal prosth r elbow joint, init | Can lead a claim, code first applies | E | None |
| M97.41XD | Periprosthetic fracture around internal prosthetic right elbow joint, subsequent encounterCMS: Periprosth fx around internal prosth r elbow joint, subs | Can lead a claim, code first applies | E | None |
| M97.41XS | Periprosthetic fracture around internal prosthetic right elbow joint, sequelaCMS: Periprosth fx around internal prosth r elbow joint, sequela | Can lead a claim, code first applies | E | None |
| M97.42 Periprosthetic fracture around internal prosthetic left elbow joint | ||||
| M97.42XA | Periprosthetic fracture around internal prosthetic left elbow joint, initial encounterCMS: Periprosth fx around internal prosth l elbow joint, init | Can lead a claim, code first applies | E | None |
| M97.42XD | Periprosthetic fracture around internal prosthetic left elbow joint, subsequent encounterCMS: Periprosth fx around internal prosth l elbow joint, subs | Can lead a claim, code first applies | E | None |
| M97.42XS | Periprosthetic fracture around internal prosthetic left elbow joint, sequelaCMS: Periprosth fx around internal prosth l elbow joint, sequela | Can lead a claim, code first applies | E | None |
| M97.8 Periprosthetic fracture around other internal prosthetic joint | ||||
| M97.8XXA | Periprosthetic fracture around other internal prosthetic joint, initial encounterCMS: Periprosth fracture around other internal prosth joint, init | Can lead a claim, code first applies | E | None |
| M97.8XXD | Periprosthetic fracture around other internal prosthetic joint, subsequent encounterCMS: Periprosth fracture around other internal prosth joint, subs | Can lead a claim, code first applies | E | None |
| M97.8XXS | Periprosthetic fracture around other internal prosthetic joint, sequelaCMS: Periprosth fx around other internal prosth joint, sequela | Can lead a claim, code first applies | E | None |
| M97.9 Periprosthetic fracture around unspecified internal prosthetic joint | ||||
| M97.9XXA | Periprosthetic fracture around unspecified internal prosthetic joint, initial encounterCMS: Periprosth fracture around unsp internal prosth joint, init | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| M97.9XXD | Periprosthetic fracture around unspecified internal prosthetic joint, subsequent encounterCMS: Periprosth fracture around unsp internal prosth joint, subs | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| M97.9XXS | Periprosthetic fracture around unspecified internal prosthetic joint, sequelaCMS: Periprosth fx around unsp internal prosth joint, sequela | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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