2025 ICD-10-CM code M96
This code describes complications during or after musculoskeletal procedures, and disorders not classified elsewhere.
Modifiers may be applicable depending on the specific scenario and the payer's requirements.Consult official coding guidelines for details.
Medical necessity must be established by demonstrating the relationship between the musculoskeletal complication/disorder and the procedure performed. Clear documentation supporting the diagnosis and the need for further intervention or treatment is essential.
In simple words: This code is used when someone experiences a problem with their muscles, bones, or joints during or after a medical procedure, and there isn't a more specific code to describe it.These problems can include things like pain, stiffness, decreased movement, or even fractures near an implant.
This ICD-10-CM code (M96) identifies intraoperative and postprocedural complications and disorders of the musculoskeletal system that are not classified under a more specific code. This includes a range of conditions that may arise during or following surgical procedures or other interventions involving the musculoskeletal system. Examples include pseudarthrosis after fusion, postlaminectomy syndrome, post-radiation kyphosis or scoliosis, and fractures following implant insertion.
Example 1: A patient develops a postlaminectomy syndrome, characterized by persistent pain and stiffness, following a spinal surgery.There is no other specific code to describe this complication, thus, M96.1 is used., A patient experiences a fracture of the femur following the insertion of a hip prosthesis. Code M96.65 is assigned to capture this specific post-procedural complication., During arthroscopic knee surgery, the surgeon encounters unexpected difficulty manipulating the instruments due to excessive scar tissue from a previous injury. While the surgery proceeds successfully, there is no specific code to capture this intraoperative finding. Consequently, M96.89 is applied to denote the other unspecified intraoperative complication of the musculoskeletal system.
Detailed documentation of the complication or disorder, including the specific location, nature of the issue (e.g., pain, stiffness, fracture), and relationship to the procedure, is crucial. Diagnostic tests, such as X-rays or MRI scans, should be documented to support the diagnosis.
** Excludes2: 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)
- Modifier TC rule: The application of TC modifiers depends on the specific procedure and circumstances. Review official coding and payer-specific guidelines for appropriate usage.
- Specialties:Orthopedic Surgery, Neurosurgery, General Surgery, Physiatry, Physical Therapy, Pain Management
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Physician's Office