S72.026D

S72.026D: Nondisplaced fracture of epiphysis (separation) (upper) of unspecified femur, subsequent encounter for closed fracture with routine healing

Billable / specific codeICD-10-CMPOA exempt

S72.026D is a billable, specific ICD-10-CM code for nondisplaced fracture of epiphysis (separation) (upper) of unspecified femur, subsequent encounter for closed fracture with routine healing. It is valid for submission on a claim.

Check S72.026D with the rest of the claim: free scrubber

7th character "D": subsequent encounter for closed fracture with routine healing

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 S72.026D

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 S72.026D

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 S72.026D

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

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

S72.026D is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

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

Code history

Unchanged in every release from FY2024 to FY2027.