Is S72.26XM a billable ICD-10-CM code?

Yes. S72.26XM is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S72.26XM 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 S72.26XM?

S72.26XM 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 S72.26XM (S72) and apply to it just the same.

S72.26XM

S72.26XM — Nondisplaced subtrochanteric fracture of unspecified femur, subsequent encounter for open fracture type I or II with nonunion

Billable / specific codeICD-10-CMPOA exempt

S72.26XM is a billable, specific ICD-10-CM code for nondisplaced subtrochanteric fracture of unspecified femur, subsequent encounter for open fracture type i or ii with nonunion. It is valid for submission on a claim.

7th character "M" — subsequent encounter for open fracture type I or II with nonunion

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 S72.26XM

These are not written on S72.26XM, but they bind it: a note on a category applies to every code beneath it. Billing S72.26XM with anything listed here is a denial.

Written on S72 — Fracture of femur

traumatic amputation of hip and thigh (S78.-)

Excludes2 inherited from the categories above S72.26XM

Also inherited, and the opposite of Excludes1: these conditions are not part of S72.26XM, but a patient can have both, so you may code both.

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 S72.26XM

These codes carry an Excludes1 note pointing at S72.26XM. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S72.26XM alone.

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

Risk adjustment

S72.26XM does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

S72.26XM 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

S72.26XM 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 S72.26. If S72.26XM is not quite right, the correct code is usually one of these.

Questions about S72.26XM

Is S72.26XM a billable ICD-10-CM code?: Yes. S72.26XM is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S72.26XM 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 S72.26XM?: S72.26XM 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 S72.26XM (S72) and apply to it just the same.