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v1.0.0
ICD-10 Guide
ICD-10 CodesS72.409

S72.409

Billable

Unspecified fracture of lower end of unspecified femur

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

Code Description

ICD-10 S72.409 is a billable code used to indicate a diagnosis of unspecified fracture of lower end of unspecified femur.

Key Diagnostic Point:

The S72.409 code is used to classify an unspecified fracture at the lower end of the femur, which is a critical area for mobility and weight-bearing. This type of fracture can occur due to various mechanisms, including falls, direct trauma, or pathological conditions such as osteoporosis. The lower end of the femur is particularly susceptible to fractures in elderly populations, often resulting from low-energy falls. Clinically, these fractures may present with pain, swelling, and inability to bear weight on the affected leg. Diagnosis typically involves imaging studies such as X-rays or CT scans to confirm the fracture and assess for any associated injuries, such as dislocations or ligament tears. Treatment may vary from conservative management with immobilization to surgical intervention, depending on the fracture's complexity and the patient's overall health status. Understanding the nuances of this code is essential for accurate billing and ensuring appropriate care pathways are followed.

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., dislocations)
  • Differentiation from other femoral fractures

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to specify laterality (left/right)
  • Lack of imaging reports to support diagnosis
  • Inconsistent terminology in clinical notes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging results, and pre-operative assessments are crucial.

Common Clinical Scenarios

Fractures resulting from falls in elderly patients, sports injuries in younger populations.

Billing Considerations

Ensure clear documentation of fracture type and treatment plan to support coding.

Emergency Medicine

Documentation Requirements

Thorough documentation of patient history, mechanism of injury, and initial assessment findings.

Common Clinical Scenarios

Patients presenting with acute limb pain after trauma, requiring immediate imaging.

Billing Considerations

Accurate coding is essential for proper triage and treatment planning.

Coding Guidelines

Inclusion Criteria

Use S72.409 When
  • According to ICD
  • 10 guidelines, this code should be used when the specific type of fracture is not documented
  • Coders should ensure that the documentation supports the use of this unspecified code and consider the need for more specific codes if available

Exclusion Criteria

Do NOT use S72.409 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27447CPT Code

Open treatment of femoral fracture

Clinical Scenario

Used when surgical intervention is required for a lower end femur fracture.

Documentation Requirements

Operative report detailing the procedure performed and any implants used.

Specialty Considerations

Orthopedic surgeons must ensure that the procedure aligns with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding fractures, but the use of unspecified codes like S72.409 can lead to challenges in tracking outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding fractures, but the use of unspecified codes like S72.409 can lead to challenges in tracking outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specificity in coding fractures, but the use of unspecified codes like S72.409 can lead to challenges in tracking outcomes and resource allocation.

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

When should I use S72.409?

Use S72.409 when a patient has a fracture at the lower end of the femur, and the specific type of fracture is not documented. Ensure that the documentation supports the use of this unspecified code.