M96.622
BillableFracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm
HCC Category Mapping
V24HCC 176 — Complications of Specified Implanted Device or Graft
0.529ESRDHCC 176 — Complications of Specified Implanted Device or Graft
0.000What This Code Means
A broken upper arm bone (humerus) on the left side that occurs as a complication after surgical implants, joint replacements, or bone plates were inserted.
Coding Tips
- •Use this code specifically for left-sided fractures; verify laterality in imaging reports
- •Link to the original orthopedic procedure that placed the implant
Clinical Significance
This code represents a postoperative complication where the left humerus fractures following orthopedic implant insertion, requiring complex medical and surgical management. The diagnosis significantly impacts risk adjustment modeling due to revision surgery needs and potential long-term functional limitations.
Documentation Requirements
- ✓Documentation of prior orthopedic implant, prosthesis, or bone plate insertion
- ✓Confirmation of left humerus fracture occurring subsequent to implant procedure
- ✓Specific identification of left arm as the affected site
- ✓Clear temporal relationship between implant placement and fracture development
- ✓Current management plan including fracture treatment and implant evaluation
- ✓Assessment of implant integrity and revision surgery considerations
- ✓Clinical notes excluding external trauma as fracture cause
- ✓Provider documentation confirming complication relationship to prior procedure
Commonly Confused Codes
S42.302A — Fracture of left humerus, initial encounter without implant relationshipM96.621 — Same complication but affecting right arm rather than leftT84.022A — Breakdown of internal fixation device of left humerusM96.629 — Same complication but unspecified arm rather than specifically leftZ96.61 — Presence of orthopedic joint implant without complications
Code Hierarchy
└M96Intraoperative and postprocedural complications and disorders of musculoskeletal system, not elsewhere classified└M96.6Fracture of bone following insertion of orthopedic implant, joint prosthesis, or bone plate└M96.62Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate└M96.622Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm
└M96.622Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm