S72.021A

S72.021A: Displaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture

Billable / specific codeICD-10-CMright

S72.021A is a billable, specific ICD-10-CM code for displaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for closed fracture. It is valid for submission on a claim.

Check S72.021A with the rest of the claim: free scrubber

7th character "A": initial encounter for closed fracture

The appropriate 7th character is to be added to all codes from category S72

A: initial encounter for closed fracture
B: initial encounter for open fracture type I or II
C: initial encounter for open fracture type IIIA, IIIB, or IIIC
D: subsequent encounter for closed fracture with routine healing
E: subsequent encounter for open fracture type I or II with routine healing
F: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
G: subsequent encounter for closed fracture with delayed healing
H: subsequent encounter for open fracture type I or II with delayed healing
J: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
K: subsequent encounter for closed fracture with nonunion
M: subsequent encounter for open fracture type I or II with nonunion
N: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
P: subsequent encounter for closed fracture with malunion
Q: subsequent encounter for open fracture type I or II with malunion
R: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S: sequela

Excludes1 inherited from the categories above S72.021A

A category’s note binds every code beneath it.

Written on S72.02: Fracture of epiphysis (separation) (upper) of femur

capital femoral epiphyseal fracture (pediatric) of femur (S79.01-)
Salter-Harris Type I physeal fracture of upper end of femur (S79.01-)

Written on S72: Fracture of femur

traumatic amputation of hip and thigh (S78.-)

Excludes2 inherited from the categories above S72.021A

Not part of this code, but both may be coded when both are present.

Written on S72.0: Fracture of head and neck of femur

physeal fracture of lower end of femur (S79.1-)
physeal fracture of upper end of femur (S79.0-)

Written on S72: Fracture of femur

fracture of lower leg and ankle (S82.-)
fracture of foot (S92.-)
periprosthetic fracture of prosthetic implant of hip (M97.0-)

Other codes that can never be billed with S72.021A

Their own Excludes1 notes name this code, so the conflict is not listed above.

M84.3Stress fracture
M84.4Pathological fracture, not elsewhere classified
S71Open wound of hip and thigh

Risk adjustment

S72.021A risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 402 Hip Fracture/Dislocation0.467 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

S72.021A is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52465Knee Orthoses - Policy Article
A56421Billing and Coding: CT of the Abdomen and Pelvis
A56777Billing and Coding: Total Joint Arthroplasty
A56796Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)

Code history

Unchanged in every release from FY2024 to FY2027.