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ICD-10 Guide
ICD-10 CodesS72.42

S72.42

Billable

Fracture of lateral condyle of femur

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

Code Description

ICD-10 S72.42 is a billable code used to indicate a diagnosis of fracture of lateral condyle of femur.

Key Diagnostic Point:

The lateral condyle of the femur is a critical area of the knee joint, and fractures in this region can significantly impact mobility and function. A fracture of the lateral condyle of the femur typically occurs due to high-energy trauma, such as falls or vehicular accidents, but can also result from low-energy injuries in osteoporotic patients. Clinically, patients may present with knee pain, swelling, and an inability to bear weight on the affected leg. Diagnosis is confirmed through imaging studies, including X-rays and possibly MRI, to assess the extent of the fracture and any associated soft tissue injuries. Treatment often involves orthopedic intervention, which may include surgical fixation to restore stability and alignment, especially in displaced fractures. Rehabilitation is crucial for recovery, focusing on restoring range of motion and strength. Complications can include nonunion, malunion, and post-traumatic arthritis, making accurate diagnosis and management essential for optimal outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture patterns (e.g., displaced vs. non-displaced)
  • Need for precise documentation of imaging findings
  • Potential for associated injuries (e.g., ligamentous injuries)
  • Variations in treatment approaches (surgical vs. conservative)

Audit Risk Factors

  • Inadequate documentation of fracture type and displacement
  • Failure to document associated injuries or complications
  • Incorrect coding of laterality (left vs. right)
  • Misinterpretation of imaging results

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up notes are essential for accurate coding.

Common Clinical Scenarios

Fractures due to falls in elderly patients, sports injuries in younger patients, and post-traumatic cases.

Billing Considerations

Ensure that all surgical interventions and any complications are thoroughly documented.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional status and rehabilitation progress are necessary.

Common Clinical Scenarios

Patients recovering from surgical fixation of the fracture, focusing on mobility and strength training.

Billing Considerations

Documenting the patient's baseline function and progress is critical for coding rehabilitation services.

Coding Guidelines

Inclusion Criteria

Use S72.42 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code accurately reflects the diagnosis based on clinical documentation
  • Include details about the fracture type, laterality, and any associated injuries

Exclusion Criteria

Do NOT use S72.42 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27405CPT Code

Open treatment of femoral condyle fracture

Clinical Scenario

Used when surgical intervention is performed for a displaced lateral condyle fracture.

Documentation Requirements

Operative report detailing the procedure, findings, and post-operative care.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and any fixation devices used.

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 laterality and type, which enhances the accuracy of patient records and billing.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including laterality and type, which enhances the accuracy of patient records and billing.

Reimbursement & Billing Impact

billing.

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 significance of coding S72.42 accurately?

Accurate coding of S72.42 is crucial for proper reimbursement, tracking of orthopedic injuries, and ensuring appropriate patient management. It also aids in research and quality improvement initiatives within healthcare.