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ICD-10 Guide
ICD-10 CodesS72.01

S72.01

Billable

Unspecified intracapsular fracture of femur

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

Code Description

ICD-10 S72.01 is a billable code used to indicate a diagnosis of unspecified intracapsular fracture of femur.

Key Diagnostic Point:

An unspecified intracapsular fracture of the femur refers to a break in the femur bone that occurs within the hip joint capsule. This type of fracture is commonly associated with falls, particularly in elderly patients, and can lead to significant morbidity due to complications such as avascular necrosis, nonunion, or malunion. Intracapsular fractures are categorized based on their location relative to the hip joint capsule, and they often require surgical intervention, such as internal fixation or hip replacement, to restore mobility and alleviate pain. The diagnosis is typically confirmed through imaging studies, including X-rays or MRI, which help to visualize the fracture's characteristics and assess for any associated injuries. Treatment plans are tailored to the patient's age, activity level, and overall health, with a focus on minimizing complications and promoting recovery. Given the potential for serious outcomes, accurate coding of these fractures is crucial for appropriate reimbursement and quality care management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the femur
  • Need for precise documentation of fracture characteristics
  • Potential for associated injuries requiring additional coding
  • Variations in treatment approaches impacting coding decisions

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to capture associated injuries or complications
  • Misclassification of fracture type
  • Inconsistent coding practices across providers

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed descriptions of fracture type, location, and treatment plan, including imaging results.

Common Clinical Scenarios

Patients presenting with hip pain after a fall, requiring surgical intervention for fracture repair.

Billing Considerations

Ensure documentation reflects the urgency of treatment and any complications that may arise.

Emergency Medicine

Documentation Requirements

Accurate assessment of injury mechanism, initial imaging results, and any immediate interventions performed.

Common Clinical Scenarios

Patients arriving via ambulance after a fall, with acute hip pain and potential fractures.

Billing Considerations

Document the patient's vital signs and any pre-existing conditions that may affect treatment.

Coding Guidelines

Inclusion Criteria

Use S72.01 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the code is used only when the fracture is confirmed and documented

Exclusion Criteria

Do NOT use S72.01 When
  • Exclude codes for open fractures or those requiring specific surgical procedures unless specified

Related ICD-10 Codes

Related CPT Codes

27130CPT Code

Total hip arthroplasty

Clinical Scenario

Used for patients with severe intracapsular fractures requiring hip replacement.

Documentation Requirements

Document the indication for surgery, including fracture type and patient health status.

Specialty Considerations

Orthopedic surgeons must ensure all pre-operative assessments are documented.

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 reimbursement processes. S72.01 provides a necessary option for unspecified fractures, but it requires careful documentation to avoid audit risks.

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 reimbursement processes. S72.01 provides a necessary option for unspecified fractures, but it requires careful documentation to avoid audit risks.

Reimbursement & Billing Impact

reimbursement processes. S72.01 provides a necessary option for unspecified fractures, but it requires careful documentation to avoid audit risks.

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 S72.01 and S72.02?

S72.01 is used for unspecified intracapsular fractures, while S72.02 is for extracapsular fractures. Accurate documentation is essential to determine the correct code.