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ICD-10 Guide
ICD-10 CodesS72.40

S72.40

Billable

Unspecified fracture of lower end of femur

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

Code Description

ICD-10 S72.40 is a billable code used to indicate a diagnosis of unspecified fracture of lower end of femur.

Key Diagnostic Point:

The unspecified fracture of the lower end of the femur refers to a break in the femur bone, specifically at its distal end near the knee joint. This type of fracture can occur due to various mechanisms, including high-energy trauma such as falls or vehicular accidents, or low-energy trauma in osteoporotic patients. Symptoms typically include severe pain, swelling, and inability to bear weight on the affected leg. Diagnosis is usually confirmed through imaging studies such as X-rays or CT scans. Treatment often involves orthopedic intervention, which may include surgical fixation or conservative management depending on the fracture's nature and the patient's overall health. Complications can include malunion, nonunion, or post-traumatic arthritis, particularly if the fracture involves the knee joint. Proper coding is essential for accurate billing and to ensure appropriate treatment protocols are followed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations
  • Need for precise documentation of fracture details
  • Potential for misclassification with other femoral fractures
  • Variations in treatment protocols based on fracture specifics

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to specify laterality (right or left)
  • Misuse of unspecified codes when specific codes are available
  • Inconsistent clinical notes regarding the mechanism of injury

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure that all imaging studies and treatment plans are documented to support the chosen code.

Emergency Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with acute pain and swelling after trauma, requiring immediate evaluation and stabilization.

Billing Considerations

Accurate documentation of the mechanism of injury is crucial for coding and treatment planning.

Coding Guidelines

Inclusion Criteria

Use S72.40 When
  • According to ICD
  • 10 guidelines, S72
  • 40 should be used when the specific type of fracture is not documented
  • Coders should ensure that the documentation supports the use of this unspecified code and consider more specific codes if available

Exclusion Criteria

Do NOT use S72.40 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27447CPT Code

Open treatment of femoral fracture

Clinical Scenario

Used when surgical intervention is required for fracture stabilization.

Documentation Requirements

Operative reports detailing the procedure and any complications.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and the surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding fractures, which can improve treatment planning and reimbursement accuracy. However, the use of unspecified codes like S72.40 may indicate a need for better documentation practices.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding fractures, which can improve treatment planning and reimbursement accuracy. However, the use of unspecified codes like S72.40 may indicate a need for better documentation practices.

Reimbursement & Billing Impact

reimbursement accuracy. However, the use of unspecified codes like S72.40 may indicate a need for better documentation practices.

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

When should I use S72.40 instead of a more specific code?

S72.40 should be used when the documentation does not specify the type of fracture. If the fracture type is known, a more specific code should be used to ensure accurate coding and billing.