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ICD-10 Guide
ICD-10 CodesS72.426

S72.426

Billable

Nondisplaced fracture of lateral condyle of unspecified femur

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

Code Description

ICD-10 S72.426 is a billable code used to indicate a diagnosis of nondisplaced fracture of lateral condyle of unspecified femur.

Key Diagnostic Point:

A nondisplaced fracture of the lateral condyle of the femur refers to a break in the bone that does not result in the bone fragments being misaligned. This type of fracture typically occurs in the context of trauma, such as falls or sports injuries, and is often seen in pediatric populations due to their higher activity levels. The lateral condyle is a critical area of the femur that contributes to knee stability and function. Symptoms may include localized pain, swelling, and limited range of motion in the knee joint. Diagnosis is usually confirmed through imaging studies, such as X-rays or MRI, which can help differentiate between nondisplaced and displaced fractures. Treatment often involves conservative management, including rest, immobilization, and physical therapy, although surgical intervention may be necessary in certain cases to ensure proper healing and restore function. Understanding the implications of this fracture is essential for orthopedic specialists, as it can significantly impact a patient's mobility and quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding the anatomical location and its implications for treatment
  • Variability in documentation practices among providers
  • Potential for associated injuries in the knee joint

Audit Risk Factors

  • Inadequate documentation of the fracture type
  • Failure to specify laterality when applicable
  • Misclassification of fracture displacement
  • Lack of imaging reports in the medical record

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed imaging reports, surgical notes if applicable, and follow-up assessments.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or vehicular accidents.

Billing Considerations

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

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Patients recovering from femoral fractures requiring rehabilitation.

Billing Considerations

Documenting progress and functional outcomes is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use S72.426 When
  • According to ICD
  • 10 coding guidelines, this code should be used when the fracture is confirmed as nondisplaced and the specific location is documented
  • It is important to follow the guidelines for laterality and to ensure that the fracture is not part of a more complex injury requiring a different code

Exclusion Criteria

Do NOT use S72.426 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27405CPT Code

Arthroscopy, knee, diagnostic, with or without synovial biopsy

Clinical Scenario

Used when assessing knee joint injuries, including fractures.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure clear linkage between diagnosis and procedure.

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 patient records and treatment plans. S72.426 provides a clear distinction for nondisplaced fractures, which aids in appropriate management and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and treatment plans. S72.426 provides a clear distinction for nondisplaced fractures, which aids in appropriate management and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 fracture?

A displaced fracture involves a break where the bone fragments are misaligned, while a nondisplaced fracture means the bone remains in its normal position despite the fracture.