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ICD-10 Guide
ICD-10 CodesS72.011

S72.011

Billable

Unspecified intracapsular fracture of right femur

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

Code Description

ICD-10 S72.011 is a billable code used to indicate a diagnosis of unspecified intracapsular fracture of right femur.

Key Diagnostic Point:

An unspecified intracapsular fracture of the right femur refers to a fracture occurring within the hip joint capsule, which encompasses the femoral head and neck. 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 classified based on their location and can be further categorized into subtypes, including femoral neck fractures. The management of these fractures often involves surgical intervention, such as internal fixation or hip arthroplasty, depending on the patient's age, activity level, and overall health. Accurate diagnosis typically requires imaging studies, including X-rays or MRI, to assess the fracture's characteristics and any associated injuries. Given the potential for complications and the need for careful surgical planning, proper coding is essential for appropriate reimbursement and tracking of patient outcomes.

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
  • Differentiation from other types of femoral fractures
  • Potential for associated injuries requiring additional coding

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to capture associated injuries or complications
  • Incorrect coding of fracture type or location
  • Lack of clarity in surgical documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and preoperative assessments are essential for accurate coding.

Common Clinical Scenarios

Common scenarios include hip fractures in elderly patients, trauma cases from falls, and post-operative complications.

Billing Considerations

Surgeons must document the specific type of fracture, any surgical interventions performed, and the patient's functional status.

Emergency Medicine

Documentation Requirements

Thorough documentation of initial assessment, imaging results, and any immediate interventions performed.

Common Clinical Scenarios

Patients presenting with acute hip pain following a fall or trauma, requiring imaging and potential referral to orthopedic surgery.

Billing Considerations

Emergency physicians should ensure that the mechanism of injury and any associated injuries are clearly documented.

Coding Guidelines

Inclusion Criteria

Use S72.011 When
  • According to ICD
  • 10 coding guidelines, S72
  • 011 should be used when the specific type of intracapsular fracture is not documented
  • Coders must ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use S72.011 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27130CPT Code

Total hip arthroplasty

Clinical Scenario

Used for patients with severe fractures requiring joint replacement.

Documentation Requirements

Operative report detailing the procedure, indications, and any complications.

Specialty Considerations

Orthopedic surgeons must document the patient's functional status and preoperative assessments.

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 granularity of data for treatment outcomes and reimbursement. S72.011 provides a clear framework for coding unspecified intracapsular fractures, facilitating better tracking of patient care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the granularity of data for treatment outcomes and reimbursement. S72.011 provides a clear framework for coding unspecified intracapsular fractures, facilitating better tracking of patient care.

Reimbursement & Billing Impact

reimbursement. S72.011 provides a clear framework for coding unspecified intracapsular fractures, facilitating better tracking of patient care.

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 intracapsular and extracapsular fractures?

Intracapsular fractures occur within the hip joint capsule, affecting the blood supply to the femoral head, while extracapsular fractures occur outside the capsule and typically have a better blood supply, leading to different treatment approaches.