M96.671 ICD-10-CM Code: Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg
M96.671 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)
M96.671
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg
A fracture of the tibia or fibula (lower leg bones) on the right side that develops as a complication after surgical insertion of an orthopedic implant, prosthesis, or bone plate.
Buddy Insight
Right tibia or fibula fracture following orthopedic implant insertion represents a significant postoperative complication affecting 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 M96.671 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M96.671 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M96.671 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M96.671 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M96.671 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M96.671 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M96.671 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 M96.671 an HCC code?
Yes. M96.671 maps to Complications of Specified Implanted Device or Graft under the V24 model but is not retained in V28.
- Code
- M96.671
- Description
- Fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right 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 M96.671 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M96.671
For M96.671 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 M96.671 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M96.671 is the ICD-10-CM diagnosis code for fracture of tibia or fibula following insertion of orthopedic implant, joint prosthesis, or bone plate, right leg. A fracture of the tibia or fibula (lower leg bones) on the right side that develops as a complication after surgical insertion of an orthopedic implant, prosthesis, or bone plate. M96.671 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, M96.671 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 right leg; use M96.672 for left leg or M96.679 if laterality is unspecified. Because M96.671 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 M96.671 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Right tibia or fibula fracture following orthopedic implant insertion represents a significant postoperative complication affecting weight-bearing function. This diagnosis substantially impacts risk adjustment due to mobility limitations, complex surgical management requirements, and potential need for revision procedures.
Documentation Requirements
- ✓Clear documentation of prior orthopedic implant, prosthesis, or bone plate insertion
- ✓Confirmation of tibia or fibula fracture occurring after implant procedure
- ✓Specific identification of right leg involvement
- ✓Temporal relationship between implant placement and fracture development
- ✓Treatment plan for fracture management and implant evaluation
- ✓Assessment of weight-bearing status and ambulatory capacity
- ✓Documentation excluding external trauma as primary fracture cause
- ✓Provider statement confirming complication relationship to orthopedic procedure
Commonly Confused Codes
- •S82.91XA: Fracture of right lower leg without implant relationship
- •M96.679: Same complication but unspecified leg rather than specifically right
- •T84.053A: Periprosthetic fracture around internal prosthetic right knee joint
- •M96.672: Same complication but affecting left leg rather than right
- •Z96.653: Presence of artificial right knee joint without complications