M96.661

Billable

Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg

HCC Category Mapping

V24HCC 176 — Complications of Specified Implanted Device or Graft

0.529

ESRDHCC 176 — Complications of Specified Implanted Device or Graft

0.000

What This Code Means

A fracture of the thighbone (femur) on the right side that occurs as a complication following the insertion of an orthopedic implant, prosthesis, or bone plate.

Coding Tips

•This code is specific to the right leg; use M96.662 for left leg or M96.669 if laterality is unspecified
•Ensure documentation clearly indicates the fracture is a post-operative complication and not the original injury

Clinical Significance

Right femur fracture following orthopedic implant insertion represents a serious postoperative complication affecting the largest weight-bearing bone. This diagnosis has major risk adjustment implications due to the critical nature of femoral integrity for mobility and the complex revision procedures often required.

Documentation Requirements

✓Documentation of prior orthopedic implant, prosthesis, or bone plate insertion
✓Confirmation of right femur fracture occurring after implant procedure
✓Specific identification of right leg involvement
✓Clear temporal relationship between implant placement and fracture development
✓Treatment plan addressing fracture management and implant evaluation
✓Assessment of weight-bearing capacity and mobility status
✓Documentation excluding external trauma as fracture cause
✓Provider statement confirming complication relationship to prior procedure

Commonly Confused Codes

S72.91XA — Fracture of right femur without implant relationship M96.669 — Same complication but unspecified leg rather than specifically right T84.051A — Periprosthetic fracture around internal prosthetic right hip joint M96.662 — Same complication but affecting left leg rather than right Z96.641 — Presence of right artificial hip joint 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 └M96.66Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate └M96.661Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg

└M96.661Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg