M96.629
BillableFracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified 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) that occurs as a complication after surgical implants, joint replacements, or bone plates were inserted, when the specific side is not documented.
Coding Tips
- •Use only when laterality cannot be determined from the medical record
- •Query the provider if possible to determine right versus left for more specific coding
Clinical Significance
Humerus fracture following orthopedic implant insertion in unspecified arm represents a serious postoperative complication requiring complex management. This diagnosis significantly impacts risk adjustment due to revision surgery needs, extended recovery periods, and potential functional limitations affecting daily activities.
Documentation Requirements
- ✓Clear documentation of prior orthopedic implant, prosthesis, or bone plate insertion
- ✓Confirmation of humerus fracture occurring after the implant procedure
- ✓Clinical evidence that fracture is related to prior orthopedic intervention
- ✓Treatment plan addressing fracture management and implant assessment
- ✓Assessment of implant stability and potential need for revision
- ✓Documentation excluding external traumatic causes
- ✓Provider statement confirming complication relationship to prior procedure
- ✓Functional assessment and rehabilitation planning documentation
Commonly Confused Codes
S42.309A — Fracture of unspecified humerus without implant relationshipM96.621 — Same complication but specifically right arm rather than unspecifiedM96.622 — Same complication but specifically left arm rather than unspecifiedT84.019A — Breakdown of internal fixation device of unspecified humerusZ96.69 — Presence of other orthopedic joint implants 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└M96.629Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm
└M96.629Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, unspecified arm