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ICD-10 Guide
ICD-10 CodesS72.026

S72.026

Billable

Nondisplaced fracture of epiphysis (separation) (upper) of unspecified femur

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/25/2025

Code Description

ICD-10 S72.026 is a billable code used to indicate a diagnosis of nondisplaced fracture of epiphysis (separation) (upper) of unspecified femur.

Key Diagnostic Point:

A nondisplaced fracture of the epiphysis of the upper femur refers to a type of injury where the bone has not shifted out of alignment, but there is a separation at the growth plate (epiphysis). This condition is particularly relevant in pediatric and adolescent populations where the growth plates are still open. Such fractures can occur due to trauma, falls, or sports injuries. The upper femur is critical for hip stability and mobility, and injuries in this area can lead to complications such as avascular necrosis if not properly managed. Treatment typically involves immobilization and monitoring, with surgical intervention considered in cases of significant instability or associated injuries. Accurate coding is essential for appropriate management and reimbursement, as these fractures can significantly impact a patient's mobility and quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Identifying the specific location of the fracture within the femur
  • Understanding the implications of epiphyseal injuries in pediatric patients
  • Navigating the nuances of coding for unspecified locations

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the laterality of the fracture
  • Misclassification of fracture type (displaced vs. nondisplaced)
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and follow-up assessments are essential for accurate coding.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or motor vehicle accidents.

Billing Considerations

Orthopedic surgeons must document the exact location and type of fracture to ensure correct coding.

Pediatrics

Documentation Requirements

Growth plate involvement must be clearly documented, along with any potential impact on growth.

Common Clinical Scenarios

Injuries from play or sports activities leading to epiphyseal fractures.

Billing Considerations

Pediatricians should be aware of the implications of epiphyseal injuries on future growth and development.

Coding Guidelines

Inclusion Criteria

Use S72.026 When
  • According to ICD
  • 10 guidelines, S72
  • 026 should be used when there is a nondisplaced fracture of the upper femur's epiphysis
  • Coders must ensure that the documentation supports the diagnosis and that the fracture is confirmed through imaging

Exclusion Criteria

Do NOT use S72.026 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27506CPT Code

Open treatment of femoral neck fracture

Clinical Scenario

Used when surgical intervention is required for a nondisplaced fracture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must provide clear documentation of the fracture type and treatment rationale.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the differentiation between displaced and nondisplaced fractures, which is crucial for treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the differentiation between displaced and nondisplaced fractures, which is crucial for treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the significance of coding S72.026 accurately?

Accurate coding of S72.026 is crucial for ensuring appropriate treatment and reimbursement. It helps in tracking the incidence of pediatric fractures and informs clinical decision-making.