M96.65
BillableFracture of pelvis following insertion of orthopedic implant, joint prosthesis, or bone plate
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 fracture of the pelvis that develops as a complication after surgical insertion of an orthopedic implant, joint prosthesis, or bone plate.
Coding Tips
- •This code does not differentiate by laterality since the pelvis is a midline structure
- •Document the relationship between the original orthopedic procedure and the subsequent pelvic fracture to support medical necessity
Clinical Significance
Pelvic fracture following orthopedic implant insertion represents a severe postoperative complication with major implications for mobility and stability. This diagnosis significantly impacts risk adjustment due to the critical nature of pelvic integrity for weight-bearing and the complex surgical management required.
Documentation Requirements
- ✓Clear documentation of prior orthopedic implant, prosthesis, or bone plate insertion
- ✓Confirmation of pelvic fracture occurring subsequent to implant procedure
- ✓Clinical evidence establishing relationship between implant and fracture occurrence
- ✓Comprehensive treatment plan for pelvic fracture management
- ✓Assessment of implant stability and potential need for revision surgery
- ✓Evaluation of weight-bearing status and mobility limitations
- ✓Documentation excluding external trauma as primary cause
- ✓Provider statement confirming complication relationship to orthopedic procedure
Commonly Confused Codes
S32.9XXA — Fracture of pelvis without implant relationship, initial encounterT84.048A — Loosening of internal fixation device of pelvisM96.69 — Fracture of other bone following orthopedic implant insertionZ96.65 — Presence of pelvic joint implant without complicationsM80.88XA — Other osteoporotic fracture of pelvis without implant relation