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v1.0.0
ICD-10 Guide
ICD-10 CodesS72.05

S72.05

Billable

Unspecified fracture of head of femur

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

Code Description

ICD-10 S72.05 is a billable code used to indicate a diagnosis of unspecified fracture of head of femur.

Key Diagnostic Point:

An unspecified fracture of the head of the femur refers to a break in the uppermost part of the thigh bone, which is crucial for hip joint stability and mobility. This type of fracture is often associated with falls, particularly in elderly patients, and can lead to significant morbidity due to complications such as avascular necrosis, nonunion, or osteoarthritis. The head of the femur is the rounded top of the femur that fits into the acetabulum of the pelvis, forming the hip joint. Fractures in this area can be classified into various types, including intracapsular and extracapsular fractures, but when unspecified, it indicates that the exact nature of the fracture has not been detailed. Treatment typically involves surgical intervention, such as hip arthroplasty or internal fixation, depending on the patient's age, activity level, and overall health. Accurate coding is essential for appropriate management and reimbursement, as well as for tracking outcomes in orthopedic trauma surgery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the femur
  • Need for precise documentation of fracture characteristics
  • Differentiation from other hip-related injuries
  • Potential for complications that may alter treatment plans

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to specify laterality (right or left)
  • Lack of clarity on treatment provided
  • Inconsistent coding with clinical notes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up notes are essential to support the diagnosis and treatment plan.

Common Clinical Scenarios

Patients presenting with hip pain after a fall, elderly patients with mobility issues, and those requiring surgical intervention.

Billing Considerations

Ensure that all imaging results and surgical notes clearly describe the fracture type and treatment provided.

Emergency Medicine

Documentation Requirements

Accurate initial assessment notes, imaging results, and any immediate interventions performed.

Common Clinical Scenarios

Patients presenting to the emergency department with acute hip pain following trauma.

Billing Considerations

Document the mechanism of injury and any relevant comorbidities that may affect treatment.

Coding Guidelines

Inclusion Criteria

Use S72.05 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the fracture type is unspecified
  • Include any relevant external cause codes if applicable

Exclusion Criteria

Do NOT use S72.05 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27130CPT Code

Total hip arthroplasty

Clinical Scenario

Used for patients with severe fractures of the head of the femur requiring joint replacement.

Documentation Requirements

Operative report detailing the procedure and indication for surgery.

Specialty Considerations

Orthopedic surgeons must document 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 detailed coding of fractures, improving the specificity of patient records and enhancing the ability to track outcomes and complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more detailed coding of fractures, improving the specificity of patient records and enhancing the ability to track outcomes and complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more detailed coding of fractures, improving the specificity of patient records and enhancing the ability to track outcomes and complications.

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 difference between S72.05 and S72.01?

S72.05 is used for unspecified fractures of the head of the femur, while S72.01 specifically refers to fractures of the neck of the femur. Accurate coding requires understanding the specific location of the fracture.