2025 ICD-10-CM code M97.12XA
Periprosthetic fracture around internal prosthetic left knee joint, initial encounter.
Medical necessity for treatment depends on the type and severity of the fracture. It must be clearly documented why the chosen treatment (conservative or surgical) is required to address the fracture and improve the patient's condition. This documentation may include pain level, functional limitations, and risk of further complications.
Diagnosis and treatment of the periprosthetic fracture. This includes determining the cause and type of fracture, imaging studies, pain management, and potential surgical intervention or immobilization.
- Diseases of the musculoskeletal system and connective tissue (M00-M99)
- M97 Periprosthetic fracture around internal prosthetic jointM97.1 Periprosthetic fracture around internal prosthetic knee jointM97.12 Periprosthetic fracture around internal prosthetic left knee jointM97.12XA Periprosthetic fracture around internal prosthetic left knee joint, initial encounter
In simple words: A broken bone around an artificial left knee joint, first visit.
A fracture that occurs around an internal prosthetic left knee joint. This code is used for the initial encounter.
Example 1: A patient presents to the emergency room after falling and reports pain in their left knee, which has a prosthetic joint. X-rays reveal a periprosthetic fracture., A patient with a history of a left knee replacement experiences increasing pain and instability. Imaging confirms a periprosthetic fracture., During a routine follow-up visit, a patient with a left knee prosthesis is found to have a periprosthetic fracture, though they are asymptomatic.
Clinical documentation should support the diagnosis of a periprosthetic fracture. This includes:1. History of the injury or onset of symptoms.2. Physical exam findings.3. Imaging studies (X-ray, CT, MRI) confirming the fracture and its location around the prosthesis.4. Type of fracture (traumatic, pathologic).5. Associated complications, if any.
** If applicable, use an external cause code following the code for the musculoskeletal condition to identify the cause.
- Payment Status: Active
- Specialties:Orthopedic Surgery
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, Office