S72.402C: Unspecified fracture of lower end of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.402C is a billable, specific ICD-10-CM code for unspecified fracture of lower end of left femur, initial encounter for open fracture type iiia, iiib, or iiic. It is valid for submission on a claim.
Check S72.402C with the rest of the claim: free scrubber7th character "C": initial encounter for open fracture type IIIA, IIIB, or IIIC
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 S72.402C
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S72.402C
Not part of this code, but both may be coded when both are present.
Written on S72.4: Fracture of lower end of femur
Other codes that can never be billed with S72.402C
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
S72.402C 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
S72.402C is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52465Knee Orthoses - Policy Article
- A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
- A57685Billing and Coding: Total Knee Arthroplasty
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S72.402
- S72.402AUnspecified fracture of lower end of left femur, initial encounter for closed fracture
- S72.402BUnspecified fracture of lower end of left femur, initial encounter for open fracture type I or II
- S72.402DUnspecified fracture of lower end of left femur, subsequent encounter for closed fracture with routine healing
- S72.402EUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type I or II with routine healing
- S72.402FUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
- S72.402GUnspecified fracture of lower end of left femur, subsequent encounter for closed fracture with delayed healing
- S72.402HUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type I or II with delayed healing
- S72.402JUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
- S72.402KUnspecified fracture of lower end of left femur, subsequent encounter for closed fracture with nonunion
- S72.402MUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type I or II with nonunion
- S72.402NUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
- S72.402PUnspecified fracture of lower end of left femur, subsequent encounter for closed fracture with malunion
- S72.402QUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type I or II with malunion
- S72.402RUnspecified fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
- S72.402SUnspecified fracture of lower end of left femur, sequela