M96.632 ICD-10-CM Code: Fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm
M96.632 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC 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)
M96.632
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm
A broken forearm bone (radius or ulna) on the left side that occurs as a complication after surgical implants, joint replacements, or bone plates were inserted.
Buddy Insight
This diagnosis represents a postoperative complication where radius or ulna fractures in the left arm following orthopedic implant insertion, requiring complex surgical management.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
MappedHCC 176
RAF 0.582
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 176
RAF 0.000
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M96.632 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M96.632 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M96.632 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M96.632 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M96.632 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M96.632 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M96.632 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 →
Is M96.632 an HCC code?
Yes. M96.632 maps to Complications of Specified Implanted Device or Graft under the V24 model but is not retained in V28.
- Code
- M96.632
- Description
- Fracture of radius or ulna 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
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 M96.632 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M96.632
For M96.632 to 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 M96.632 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M96.632 is the ICD-10-CM diagnosis code for fracture of radius or ulna following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm. A broken forearm bone (radius or ulna) on the left side that occurs as a complication after surgical implants, joint replacements, or bone plates were inserted. M96.632 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, M96.632 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 forearm fractures. Because M96.632 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 M96.632 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 forearm fractures
- •Confirm laterality and bone involvement (radius, ulna, or both) from imaging documentation
Clinical Significance
This diagnosis represents a postoperative complication where radius or ulna fractures in the left arm following orthopedic implant insertion, requiring complex surgical management. The condition significantly impacts risk adjustment due to revision surgery needs and potential long-term functional impairment of the dominant or non-dominant arm.
Documentation Requirements
- ✓Clear documentation of prior orthopedic implant, prosthesis, or bone plate insertion
- ✓Confirmation of radius or ulna fracture occurring subsequent to implant procedure
- ✓Specific identification of left arm as the affected anatomical site
- ✓Temporal relationship between implant placement and fracture development
- ✓Current management approach for fracture treatment and implant assessment
- ✓Evaluation of implant stability and need for revision procedures
- ✓Clinical documentation excluding external traumatic causes
- ✓Provider statement confirming relationship to prior orthopedic procedure
Commonly Confused Codes
- •S52.92XA: Fracture of left forearm without implant complication relationship
- •M96.631: Same complication but affecting right arm rather than left
- •T84.123A: Breakdown of internal fixation device of left forearm
- •M96.639: Same complication but unspecified arm rather than specifically left
- •Z96.63: Presence of orthopedic joint implant without complications