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ICD-10 Guide
ICD-10 CodesS72.4

S72.4

Billable

Fracture of lower end of femur

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

Code Description

ICD-10 S72.4 is a billable code used to indicate a diagnosis of fracture of lower end of femur.

Key Diagnostic Point:

The fracture of the lower end of the femur, also known as a distal femur fracture, typically occurs just above the knee joint. This injury is common in older adults, particularly those with osteoporosis, and can result from low-energy falls or high-energy trauma such as motor vehicle accidents. The fracture may be classified as intra-articular or extra-articular, depending on whether it extends into the knee joint. Symptoms include severe pain, swelling, and inability to bear weight on the affected leg. Diagnosis is confirmed through physical examination and imaging studies, such as X-rays or CT scans. Treatment often involves surgical intervention, particularly in cases of displaced fractures, to restore alignment and stability. Surgical options may include internal fixation with plates and screws or intramedullary nailing. Rehabilitation is crucial for restoring function and mobility post-surgery, and may involve physical therapy to strengthen the surrounding muscles and improve range of motion.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types (intra-articular vs. extra-articular)
  • Need for precise documentation of fracture displacement
  • Potential for associated injuries (ligament tears, meniscal injuries)
  • Variations in surgical approaches and techniques

Audit Risk Factors

  • Inadequate documentation of fracture type and displacement
  • Failure to document associated injuries
  • Incorrect coding of surgical procedures performed
  • Lack of follow-up documentation on recovery and rehabilitation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and pre-operative assessments are essential.

Common Clinical Scenarios

Surgical repair of distal femur fractures, management of complications such as non-union or malunion.

Billing Considerations

Ensure accurate coding of the surgical approach and any additional procedures performed.

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation protocols and patient responses.

Common Clinical Scenarios

Post-operative rehabilitation following distal femur fracture repair.

Billing Considerations

Document functional assessments and progress towards mobility goals.

Coding Guidelines

Inclusion Criteria

Use S72.4 When
  • According to ICD
  • 10 coding guidelines, S72
  • 4 should be used when the fracture is confirmed through imaging
  • It is important to document the specific type of fracture and any associated injuries

Exclusion Criteria

Do NOT use S72.4 When
  • Exclusion criteria include fractures that are not located at the lower end of the femur

Related ICD-10 Codes

Related CPT Codes

27506CPT Code

Open treatment of distal femoral fracture

Clinical Scenario

Used when surgical intervention is performed for a distal femur fracture.

Documentation Requirements

Operative report detailing the procedure and any implants used.

Specialty Considerations

Orthopedic surgeons must document the surgical approach and any complications.

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 lower end of the femur, which improves data accuracy and enhances the ability to track treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the lower end of the femur, which improves data accuracy and enhances the ability to track treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including the lower end of the femur, which improves data accuracy and enhances the ability to track treatment outcomes.

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 S72.4 and S72.0?

S72.4 refers specifically to fractures at the lower end of the femur, while S72.0 pertains to fractures of the neck of the femur, which are located higher up on the femur.