octoHealth

M97.9XXA

Billable

Periprosthetic fracture around unspecified internal prosthetic joint (initial encounter)

Chapter 13: Diseases of the musculoskeletal system and connective tissue

Additional Information

From parent codes: M00-M99 (Chapter 13)

Excludes 2 — Not Included HereFrom M00-M99

Excludes2 means 'NOT INCLUDED HERE!' An Excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time.

  • arthropathic psoriasis (L40.5-)
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • compartment syndrome (traumatic) (T79.A-)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
NotesFrom M00-M99

Additional notes from parent codes that apply to this code.

  • Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

Inpatient DRG Payments

DRG 5601,076 discharges

Aftercare, Musculoskeletal System And Connective Tissue With Cc

Avg. Medicare Payment

$21,554

Total Payment$23,288
Patient Responsibility$1,733
Hospital Charge$45,278
DRG 561380 discharges

Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc

Avg. Medicare Payment

$22,237

Total Payment$23,765
Patient Responsibility$1,527
Hospital Charge$30,351
DRG 559264 discharges

Aftercare, Musculoskeletal System And Connective Tissue With Mcc

Avg. Medicare Payment

$26,847

Total Payment$29,305
Patient Responsibility$2,459
Hospital Charge$83,761