What is ICD-10 code M96.622?

M96.622 is the ICD-10-CM diagnosis code for Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm. 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. M96.622 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. M96.622 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. M96.622 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M96.622 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for M96.622?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. M96.622 was a payment HCC under V24 (Complications of Specified Implanted Device or Graft) but the V28 recalibration removed it from the risk adjustment model. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting M96.622?

Use this code specifically for left-sided fractures; verify laterality in imaging reports Link to the original orthopedic procedure that placed the implant Because M96.622 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM M96.622: Fracture of humerus

ICD-10-CM Code View

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Code lookupM96.622Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

M96.622

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm

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.

Buddy Insight

This code represents a postoperative complication where the left humerus fractures following orthopedic implant insertion, requiring complex medical and surgical management.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Mapped

HCC 176

Complications of Specified Im...

RAF 0.582

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

Mapped

HCC 176

Complications of Specified Im...

RAF 0.000

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

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

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M96.622 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M96.622 in this effective period.

Related Child Codes

Official

M96.621Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm

M96.629Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm

Includes

Official

ICD-10-CM does not list Includes notes for M96.622 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M96.622 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M96.622 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M96.622 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M96.622 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Using routine fracture codes without establishing implant complication relationship

Missing specific laterality documentation leading to unspecified coding

Not documenting clear temporal sequence between implant and fracture

Confusing with mechanical device failure rather than bone fracture complication

Common Mistakes

HCC Buddy guidance

S42.302A — Fracture of left humerus, initial encounter without implant relationship

M96.621 — Same complication but affecting right arm rather than left

T84.022A — Breakdown of internal fixation device of left humerus

M96.629 — Same complication but unspecified arm rather than specifically left

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is M96.622 an HCC code?

Yes. M96.622 maps to Complications of Specified Implanted Device or Graft under the V24 model but is not retained in V28.

Code: M96.622
Description: Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

V24HCC 176, Complications of Specified Implanted Device or Graft

0.582

ESRDHCC 176, Complications of Specified Implanted Device or Graft

0.000

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work M96.622 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M96.622

For M96.622to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M96.622 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M96.622 is the ICD-10-CM diagnosis code for fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm. 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. M96.622 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).

Under the older CMS-HCC V24 model, M96.622 maps to Complications of Specified Implanted Device or Graft (HCC 176) with a community, non-dual, aged base RAF weight of 0.582. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Use this code specifically for left-sided fractures; verify laterality in imaging reports. Because M96.622 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M96.622 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

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 relationship
•M96.621: Same complication but affecting right arm rather than left
•T84.022A: Breakdown of internal fixation device of left humerus
•M96.629: Same complication but unspecified arm rather than specifically left
•Z96.61: Presence of orthopedic joint implant without complications