M96.631
BillableFracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, right 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 forearm bone (radius or ulna) on the right side that occurs as a complication after surgical implants, joint replacements, or bone plates were inserted.
Coding Tips
- •Specify the right arm with this code; use M96.632 for left arm
- •Document whether the fracture involves the radius, ulna, or both bones
Clinical Significance
Radius or ulna fracture following orthopedic implant insertion in the right arm represents a significant postoperative complication requiring specialized management. This diagnosis substantially impacts risk adjustment due to complex care needs, potential revision procedures, and functional limitations affecting hand and arm use.
Documentation Requirements
- ✓Documentation of prior orthopedic implant, prosthesis, or bone plate insertion
- ✓Confirmation of radius or ulna fracture occurring after implant procedure
- ✓Specific identification of right arm involvement
- ✓Clear temporal relationship between implant placement and fracture occurrence
- ✓Treatment plan for fracture management and implant evaluation
- ✓Assessment of implant integrity and revision surgery considerations
- ✓Documentation excluding external trauma as primary cause
- ✓Provider statement confirming complication relationship to orthopedic procedure
Commonly Confused Codes
S52.91XA — Fracture of right forearm without implant relationshipM96.639 — Same complication but unspecified arm rather than specifically rightT84.113A — Breakdown of internal fixation device of right forearmM96.632 — Same complication but affecting left arm rather than rightZ96.62 — 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└M96.63Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate└M96.631Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm
└M96.631Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, right arm