Non-Billable / Non-Specific Code
ICD-10-CM M97.1 is the diagnosis code for Periprosthetic fracture around internal prosthetic knee joint. This code falls under the section "Periprosthetic fracture around internal prosthetic joint" within Chapter 13 — Diseases of the musculoskeletal system and connective tissue (M00-M99). It is a non-billable/non-specific ICD-10-CM code that should not be used for reimbursement. A more specific sub-code is required for billing. Medical coders and healthcare providers use this code to document and classify diagnoses in electronic health records, insurance claims, and clinical databases.
Always refer to the official ICD-10-CM Tabular List for complete coding guidelines. Ensure documentation supports the specificity of the code selected. When in doubt, consult a certified medical coder or the latest CMS guidelines.
Understanding where M97.1 sits in the ICD-10-CM classification helps ensure proper coding:
No, M97.1 is a non-billable/non-specific code. You should use a more specific sub-code for billing and reimbursement.
M97.1 is the ICD-10-CM diagnosis code for "Periprosthetic fracture around internal prosthetic knee joint". It is used by healthcare providers to classify and document this condition in medical records and insurance claims.
The parent code of M97.1 is M97 ("Periprosthetic fracture around internal prosthetic joint"). M97.1 provides a more specific classification within this category.
M97.1 is located in Section M97 — "Periprosthetic fracture around internal prosthetic joint" within Chapter 13 of the ICD-10-CM Tabular List.
M97.1 has 2 sub-code(s) that provide more specific detail: M97.11, M97.12.
Use M97.1 when the patients documented diagnosis matches "Periprosthetic fracture around internal prosthetic knee joint" and the clinical documentation supports this level of specificity. Always verify with the latest ICD-10-CM guidelines and payer requirements.
The ICD-10-CM code for Periprosthetic fracture around internal prosthetic knee joint is M97.1.
No, M97.1 is non-billable. Use a more specific sub-code for primary diagnosis billing.
M97.1 is in Chapter 13 of the ICD-10-CM Tabular List.
Yes, M97.1 is a valid ICD-10-CM code for the 2026 fiscal year, subject to official CMS updates.