M96.662 ICD-10-CM Code: Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg
M96.662 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)
M96.662
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg
A fracture of the thighbone (femur) on the left side that occurs as a complication following the insertion of an orthopedic implant, prosthesis, or bone plate.
Buddy Insight
Left femur fracture following orthopedic implant insertion represents a severe postoperative complication affecting critical weight-bearing function.
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 M96.662 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M96.662 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M96.662 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M96.662 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M96.662 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M96.662 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M96.662 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 M96.662 an HCC code?
Yes. M96.662 maps to Complications of Specified Implanted Device or Graft under the V24 model but is not retained in V28.
- Code
- M96.662
- Description
- Fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg
- 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 M96.662 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M96.662
For M96.662 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 M96.662 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M96.662 is the ICD-10-CM diagnosis code for fracture of femur following insertion of orthopedic implant, joint prosthesis, or bone plate, left leg. A fracture of the thighbone (femur) on the left side that occurs as a complication following the insertion of an orthopedic implant, prosthesis, or bone plate. M96.662 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, M96.662 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.
This code is specific to the left leg; use M96.661 for right leg or M96.669 if laterality is unspecified. Because M96.662 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 M96.662 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Left femur fracture following orthopedic implant insertion represents a severe postoperative complication affecting critical weight-bearing function. This diagnosis significantly impacts risk adjustment due to mobility limitations, complex surgical management needs, and potential for extended rehabilitation and care coordination.
Documentation Requirements
- ✓Clear documentation of prior orthopedic implant, prosthesis, or bone plate insertion
- ✓Confirmation of left femur fracture occurring subsequent to implant procedure
- ✓Specific identification of left leg as the affected anatomical site
- ✓Temporal relationship between implant placement and fracture occurrence
- ✓Comprehensive management plan for fracture treatment and implant assessment
- ✓Evaluation of weight-bearing status and ambulatory capacity
- ✓Clinical documentation excluding external traumatic causes
- ✓Provider statement confirming complication relationship to orthopedic procedure
Commonly Confused Codes
- •S72.92XA: Fracture of left femur without implant complication relationship
- •M96.661: Same complication but affecting right leg rather than left
- •T84.052A: Periprosthetic fracture around internal prosthetic left hip joint
- •M96.669: Same complication but unspecified leg rather than specifically left
- •Z96.642: Presence of left artificial hip joint without complications