Is S72.026B a billable ICD-10-CM code?

Yes. S72.026B is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S72.026B sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the hip and thigh (S70-S79).

What cannot be coded together with S72.026B?

S72.026B carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above S72.026B (S72.02, S72) and apply to it just the same.

S72.026B

S72.026B — Nondisplaced fracture of epiphysis (separation) (upper) of unspecified femur, initial encounter for open fracture type I or II

Billable / specific codeICD-10-CM

S72.026B is a billable, specific ICD-10-CM code for nondisplaced fracture of epiphysis (separation) (upper) of unspecified femur, initial encounter for open fracture type i or ii. It is valid for submission on a claim.

7th character "B" — initial encounter for open fracture type I or II

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 S72.026B

These are not written on S72.026B, but they bind it: a note on a category applies to every code beneath it. Billing S72.026B with anything listed here is a denial.

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 S72.026B

Also inherited, and the opposite of Excludes1: these conditions are not part of S72.026B, but a patient can have both, so you may code both.

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 S72.026B

These codes carry an Excludes1 note pointing at S72.026B. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S72.026B alone.

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

Risk adjustment

S72.026B 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.

Medicare coverage

S72.026B is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A57765Billing and Coding: Major Joint Replacement (Hip and Knee)

Code history

S72.026B has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share S72.026. If S72.026B is not quite right, the correct code is usually one of these.

Questions about S72.026B

Is S72.026B a billable ICD-10-CM code?: Yes. S72.026B is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S72.026B sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the hip and thigh (S70-S79).
What cannot be coded together with S72.026B?: S72.026B carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above S72.026B (S72.02, S72) and apply to it just the same.