M96.6 ICD-10-CM Code: Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate
M96.6 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified (M96)
M96.6
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceFracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Intraoperative fracture of bone during insertion of orthopedic implant, joint prosthesis, or bone plate
Excludes 2
Official- complication of internal orthopedic devices, implants or grafts (T84.-)
- arthropathic psoriasis (L40.5-)Inherited from M00-M99, M96
- certain conditions originating in the perinatal period (P04-P96)Inherited from M00-M99, M96
- certain infectious and parasitic diseases (A00-B99)Inherited from M00-M99, M96
- compartment syndrome (traumatic) (T79.A-)Inherited from M00-M99, M96
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from M00-M99, M96
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from M00-M99, M96
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from M00-M99, M96
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from M00-M99, M96
- neoplasms (C00-D49)Inherited from M00-M99, M96
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from M00-M99, M96
- arthropathy following intestinal bypass (M02.0-)Inherited from M00-M99, M96
- complications of internal orthopedic prosthetic devices, implants and grafts (T84.-)Inherited from M00-M99, M96
- disorders associated with osteoporosis (M80)Inherited from M00-M99, M96
- periprosthetic fracture around internal prosthetic joint (M97.-)Inherited from M00-M99, M96
- presence of functional implants and other devices (Z96-Z97)Inherited from M00-M99, M96
Related Codes
Includes
OfficialNo Includes notes are included in this display for M96.6. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for M96.6. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for M96.6. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for M96.6. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for M96.6. Check the code and parent instructions in the Code Book.
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
- Code
- M96.6
- Description
- Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- No
- Payment year
- 2026
Coder workflow notes
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What This Code Means
M96.6 is the ICD-10-CM diagnosis code for fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate. M96.6 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified (m96).
Header codes like M96.6 cannot be reported on claims directly; they organize child codes that share clinical context. Coders should select the billable child code that matches the documented presentation and then verify its current source-backed HCC mapping. Do not infer a child code or risk adjustment value from the header alone.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for M96.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Excludes 2, Not included here, may code separately
- complication of internal orthopedic devices, implants or grafts (T84.-)