Cracking the Code

Sequencing of a Periprosthetic Fracture

What is a periprosthetic fracture? Periprosthetic fractures occur when there is a fracture around an orthopedic implant, whether a replacement or an internal fixation device. They are associated with significant morbidity and increased mortality in some cases. All periprosthetic fractures require some form of treatment. Stable nondisplaced fractures could only require protected weight-bearing or cast/brace immobilization as well as pain medication. However, most unstable peri-implant fractures require surgical stabilization, implant replacement, or both to restore function.

Concerning the coding sequencing of a periprosthetic fracture and the actual fracture itself, instruction is quite limited but can be found in a 2016 Coding Clinic.  This coding clinic sites, “if the reason for the admission/encounter is the fracture, the specific type of fracture (traumatic or pathological) should be sequenced first and the periprosthetic fracture code should be sequenced as a secondary diagnosis code.”

Q: A 64-year-old female patient with a history of bilateral replacement presented to the hospital after having tripped and fallen sustaining a traumatic periprosthetic fracture of the lower end of the right femur. She has had no symptoms of loosening of the prosthesis prior to this fall. How is this coded?
A: We will want to look at ICD-10-CM code S72.401A, Unspecified fracture of lower end of right femur, initial encounter for closed fracture, and code M97.01XA, Periprosthetic fracture around the internal prosthetic right hip joint, initial encounter, along with the appropriate external cause code for the fall.
Reference: Coding Clinic, Fourth Quarter 2016: Page 42, ‘OrthoInfo’ from the American Academy of Orthopedic Surgeons
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