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ICD-10 Guide
ICD-10 CodesS72.091

S72.091

Billable

Other fracture of head and neck of right femur

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

Code Description

ICD-10 S72.091 is a billable code used to indicate a diagnosis of other fracture of head and neck of right femur.

Key Diagnostic Point:

The S72.091 code refers to fractures occurring in the head and neck region of the right femur, which is a critical area for hip stability and mobility. These fractures can result from various mechanisms, including falls, direct trauma, or pathological conditions such as osteoporosis. The head of the femur articulates with the acetabulum of the pelvis, and fractures in this area can lead to significant complications, including avascular necrosis, nonunion, or malunion. Patients typically present with hip pain, inability to bear weight, and may exhibit limb positioning that suggests dislocation or fracture. Diagnosis is confirmed through imaging studies such as X-rays or MRI, which help delineate the fracture type and assess for associated injuries. Treatment often involves orthopedic intervention, which may include surgical fixation or hip replacement, depending on the fracture's severity and the patient's overall health. Rehabilitation is crucial for restoring function and mobility post-injury.

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
  • Potential for associated injuries requiring additional coding
  • Differentiation from other femoral fractures and dislocations

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to capture associated injuries
  • Misclassification of fracture type
  • Inconsistent use of codes for similar injuries

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging results, and post-operative care notes.

Common Clinical Scenarios

Fractures due to falls in elderly patients, sports injuries in younger populations, and pathological fractures.

Billing Considerations

Ensure accurate documentation of fracture type, treatment approach, and any complications.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional status and rehabilitation plans.

Common Clinical Scenarios

Post-operative rehabilitation following femoral fracture repair, management of complications like avascular necrosis.

Billing Considerations

Documenting progress and functional outcomes is crucial for coding and billing.

Coding Guidelines

Inclusion Criteria

Use S72.091 When
  • According to ICD
  • 10 guidelines, S72
  • 091 should be used when the fracture is specifically identified as 'other' and not classified under more specific codes
  • Coders must ensure that the documentation supports the use of this code, including details about the fracture's location and treatment

Exclusion Criteria

Do NOT use S72.091 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27130CPT Code

Total hip arthroplasty

Clinical Scenario

Used in cases where surgical intervention is required for severe fractures.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery and any pre-existing conditions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S72.091 provides a more detailed classification than previous ICD-9 codes, facilitating better patient management and outcomes tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S72.091 provides a more detailed classification than previous ICD-9 codes, facilitating better patient management and outcomes tracking.

Reimbursement & Billing Impact

reimbursement processes. S72.091 provides a more detailed classification than previous ICD-9 codes, facilitating better patient management and outcomes tracking.

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 S72.091 and S72.001?

S72.091 is used for 'other fractures' of the head and neck of the right femur, while S72.001 specifically refers to fractures of the neck of the right femur. The distinction is important for accurate coding and treatment planning.