2025 ICD-10-CM code M96.6
(Active) Effective Date: N/A Revision Date: N/A Musculoskeletal - Fractures Chapter 13: Diseases of the musculoskeletal system and connective tissue Feed
Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate.
Modifiers may be applicable depending on the circumstances of the procedure and the payer's requirements.Consult payer-specific guidelines for applicable modifiers.
The medical necessity for coding M96.6 rests on establishing a direct causal link between the fracture and the presence or insertion of the orthopedic device.This would require thorough documentation detailing the mechanics of the fracture and eliminating other potential causes.
Orthopedic surgeon or other qualified physician responsible for managing the patient's orthopedic condition and surgical intervention.
- Chapter 13: Diseases of the musculoskeletal system and connective tissue
- M96.- Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified
In simple words: This code describes a broken bone that happened because of a surgery where a metal part (like a plate or artificial joint) was put into the bone.The break was directly caused by the metal part and not from something else.
This code is used to classify a fracture of a bone that occurs as a direct result of the insertion or presence of an orthopedic implant, joint prosthesis, or bone plate.It should only be assigned when the fracture is the sole complication and is directly caused by the implant, prosthesis, or plate.It excludes fractures resulting from other causes, even if the implant is present.The specific bone fractured should be further specified with additional codes if possible.
Example 1: A patient undergoes a total hip arthroplasty.During the procedure, a fracture of the femoral neck occurs due to the stress of implant insertion. Code M96.6 is used to classify this intraoperative fracture., A patient with a previously implanted knee prosthesis experiences a periprosthetic fracture of the tibia several months post-surgery.If the fracture is directly attributable to stress on the bone from the prosthesis (as opposed to an outside event), code M96.6 is appropriate., A patient falls and fractures their femur, which has a pre-existing intramedullary rod.Code M96.6 would not be appropriate in this instance; the fracture is attributable to the fall, not the rod itself.Injury codes from Chapter 19 would be used to classify the fracture.
Operative report detailing the fracture and its relation to the implant, pre-operative imaging showing the bone's condition, post-operative imaging documenting the fracture, and any relevant clinical notes indicating that the fracture is a direct consequence of the implant procedure.
** This code is often used in conjunction with codes specifying the location of the fracture, the type of implant, and other relevant details.Careful documentation is critical to ensure appropriate coding.
- Payment Status: Active
- Modifier TC rule: No TC modifier is applicable to this diagnosis code.
- Specialties:Orthopedics, Traumatology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center