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ICD-10 Guide
ICD-10 CodesS72.401

S72.401

Billable

Unspecified fracture of lower end of right femur

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

Code Description

ICD-10 S72.401 is a billable code used to indicate a diagnosis of unspecified fracture of lower end of right femur.

Key Diagnostic Point:

The unspecified fracture of the lower end of the right femur refers to a break in the femur bone, specifically at the distal end near the knee joint. This type of fracture can occur due to various mechanisms, including falls, direct trauma, or high-impact sports injuries. Patients may present with significant pain, swelling, and inability to bear weight on the affected leg. The diagnosis is typically confirmed through imaging studies such as X-rays or CT scans, which help to visualize the fracture and assess for any associated injuries. Treatment often involves immobilization, pain management, and in some cases, surgical intervention to realign and stabilize the bone. The complexity of this fracture can vary based on the patient's age, overall health, and the presence of any comorbid conditions that may affect healing. Understanding the specifics of the fracture, including its location and any potential complications, is crucial for effective management and coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations
  • Need for precise documentation of injury mechanism
  • Potential for associated injuries (e.g., ligament damage)
  • Variations in treatment approaches (surgical vs. conservative)

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to capture associated injuries
  • Misinterpretation of imaging results
  • Inconsistent coding of treatment modalities

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 in elderly patients, sports injuries in younger patients, and trauma from vehicular accidents.

Billing Considerations

Ensure that the mechanism of injury and any surgical interventions are clearly documented to support the coding.

Emergency Medicine

Documentation Requirements

Thorough documentation of initial assessment, imaging results, and treatment provided in the emergency setting.

Common Clinical Scenarios

Patients presenting with acute pain and swelling after trauma, requiring immediate imaging and pain management.

Billing Considerations

Accurate coding requires clear documentation of the patient's condition upon arrival and any immediate interventions performed.

Coding Guidelines

Inclusion Criteria

Use S72.401 When
  • According to ICD
  • 10 coding guidelines, fractures should be coded based on the specific site and type of fracture
  • The unspecified code should only be used when the specific details are not available
  • Coders should ensure that they follow the guidelines for coding fractures, including the use of seventh characters to indicate the encounter type

Exclusion Criteria

Do NOT use S72.401 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27447CPT Code

Open treatment of femoral fracture, distal end

Clinical Scenario

Used when surgical intervention is performed for the fracture.

Documentation Requirements

Operative reports detailing the procedure and any complications.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and the surgical approach taken.

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. S72.401 reflects the need for precise documentation to avoid ambiguity in patient records.

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. S72.401 reflects the need for precise documentation to avoid ambiguity in patient records.

Reimbursement & Billing Impact

reimbursement processes. S72.401 reflects the need for precise documentation to avoid ambiguity in patient records.

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 should I document to support the use of S72.401?

Document the mechanism of injury, specific symptoms, imaging results, and any treatment provided. Ensure that the documentation clearly indicates the fracture's location and any associated injuries.