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ICD-10 Guide
ICD-10 CodesS72.416

S72.416

Billable

Nondisplaced unspecified condyle fracture of lower end of unspecified femur

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

Code Description

ICD-10 S72.416 is a billable code used to indicate a diagnosis of nondisplaced unspecified condyle fracture of lower end of unspecified femur.

Key Diagnostic Point:

A nondisplaced condyle fracture of the lower end of the femur refers to a fracture that occurs at the distal end of the femur, specifically involving the condyles, which are the rounded ends of the femur that articulate with the tibia at the knee joint. In this case, the fracture is classified as nondisplaced, meaning that the bone fragments remain in their normal anatomical alignment. Such fractures can occur due to various mechanisms, including falls, direct trauma, or sports injuries. Although they are less common than displaced fractures, nondisplaced condyle fractures can still lead to significant pain, swelling, and limited range of motion in the knee. Diagnosis typically involves clinical evaluation and imaging studies such as X-rays or MRI to confirm the fracture and assess any associated soft tissue injuries. Treatment may include conservative management with rest, ice, compression, and elevation (RICE), along with physical therapy, or surgical intervention if there is concern for joint instability or if conservative measures fail. Proper coding is essential for accurate billing and to ensure appropriate management of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Unspecified location of the femur complicates coding.
  • Nondisplaced fractures may be misclassified as displaced.
  • Requires knowledge of anatomy and fracture types.
  • Differentiating between similar codes can be challenging.

Audit Risk Factors

  • Inadequate documentation of fracture specifics.
  • Misinterpretation of imaging results.
  • Failure to document associated injuries.
  • Incorrect coding of laterality or unspecified status.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed notes on the mechanism of injury, imaging results, and treatment plan.

Common Clinical Scenarios

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

Billing Considerations

Ensure that all imaging studies and consultations are documented to support the diagnosis.

Physical Medicine and Rehabilitation

Documentation Requirements

Assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Post-fracture rehabilitation and management of knee function.

Billing Considerations

Document progress and response to therapy to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use S72.416 When
  • Follow ICD
  • CM guidelines for coding fractures, ensuring to document the type of fracture, laterality, and any associated conditions
  • Nondisplaced fractures are coded differently than displaced fractures, and specificity is key

Exclusion Criteria

Do NOT use S72.416 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27447CPT Code

Arthroscopy, knee, surgical

Clinical Scenario

Used in cases where surgical intervention is required for joint stability.

Documentation Requirements

Detailed operative notes and imaging results.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery.

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. S72.416 provides a clear classification for nondisplaced condyle fractures, which aids in treatment planning 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. S72.416 provides a clear classification for nondisplaced condyle fractures, which aids in treatment planning and outcomes tracking.

Reimbursement & Billing Impact

reimbursement processes. S72.416 provides a clear classification for nondisplaced condyle fractures, which aids in treatment planning 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 a displaced and nondisplaced condyle fracture?

A displaced condyle fracture involves a misalignment of the bone fragments, while a nondisplaced fracture maintains normal alignment despite the fracture.