Wiki Excludes 1 & 2 note question

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G
Code: M97

Code Name: ICD-10 Code for Periprosthetic fracture around internal prosthetic joint

Block: The appropriate 7th character is to be added to each code from category M97
A = initial encounter
D = subsequent encounter
S = sequela

Details: Periprosthetic fracture around internal prosthetic joint


Excludes 2: fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6-)
breakage (fracture) of prosthetic joint (T84.01-)

Guidelines: Periprosthetic fracture around internal prosthetic joint (M97-M97.9XXS)

For more details on M97, ICD-10 Code for Periprosthetic fracture around internal prosthetic joint , visit: https://coder.aapc.com/icd-10-codes/

jdibble

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am finding some things in ICD-10 that are very confusing! I have a patient who was diagnosed with a periprosthetic supracondylar fracture of left knee. During surgery the doctor found that the prosthetic was broken and needed to be replaced. So, I looked up the code for the periprosthetic fracture and after a number of "see" something else notes, came up with T84.043A. There is an excludes 2 note for breakage of prosthetic joint - T84.01. So I go to code T84.013A for the left knee to code that per the excludes 2 note and there they have an Excludes 1 note for periprosthetic joint fracture (T84.04).

So, can I use both codes or can't I code both??

Any help is greatly appreciated!!! :eek:
 

consultingbykristin

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Was the broken/fracture around the internal prosthetic joint (which is T84.040-) or broken internal hip/knee prosthesis.

That's the key to me in looking at this. How is it described. Around the internal joint or actual broken prosthesis.

And I think that's why Excludes1 is on the T84.01- codes . The prosthesis itself is either broken, or the area around the prosthesis is broken.
 

jdibble

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Was the broken/fracture around the internal prosthetic joint (which is T84.040-) or broken internal hip/knee prosthesis.

That's the key to me in looking at this. How is it described. Around the internal joint or actual broken prosthesis.

And I think that's why Excludes1 is on the T84.01- codes . The prosthesis itself is either broken, or the area around the prosthesis is broken.
The patient sustained a periprosthetic supracondylar fracture with a femoral shaft fracture. When the surgeon performed the ORIF he found that the prosthesis was also broken and it was replaced as well as repair of the fracture.

A broken bone and a broken prosthesis - both!
 

vj_tiwari

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Hi,

Excludes Notes

The ICD-10-CM has two types of excludes notes. Each type of note has a
different definition for use but they are all similar in that they indicate
that codes excluded from each other are independent of each other.

a. Excludes1

A type 1 Excludes note is a pure excludes note. It means ?NOT
CODED HERE!?
An Excludes1 note indicates that the code excluded
should never be used at the same time as the code above the
Excludes1 note. An Excludes1 is used when two conditions cannot
occur together, such as a congenital form versus an acquired form of
the same condition.

b. Excludes2

A type 2 Excludes note represents ?Not included here?. An excludes2
note indicates that the condition excluded is not part of the
condition represented by the code, but a patient may have both
conditions at the same time. When an Excludes2 note appears
under a code, it is acceptable to use both the code and the excluded
code together, when appropriate.


Hope this helps!

VJ
 
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