S72.415A: Nondisplaced unspecified condyle fracture of lower end of left femur, initial encounter for closed fracture
S72.415A is a billable, specific ICD-10-CM code for nondisplaced unspecified condyle fracture of lower end of left femur, initial encounter for closed fracture. It is valid for submission on a claim.
Check S72.415A with the rest of the claim: free scrubber7th 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 S72.415A
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S72.415A
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 S72.415A
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
S72.415A 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
S72.415A 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
- A56777Billing and Coding: Total Joint Arthroplasty
- A57685Billing and Coding: Total Knee Arthroplasty
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S72.415
- S72.415BNondisplaced unspecified condyle fracture of lower end of left femur, initial encounter for open fracture type I or II
- S72.415CNondisplaced unspecified condyle fracture of lower end of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.415DNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for closed fracture with routine healing
- S72.415ENondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type I or II with routine healing
- S72.415FNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
- S72.415GNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for closed fracture with delayed healing
- S72.415HNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type I or II with delayed healing
- S72.415JNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
- S72.415KNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for closed fracture with nonunion
- S72.415MNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type I or II with nonunion
- S72.415NNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
- S72.415PNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for closed fracture with malunion
- S72.415QNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type I or II with malunion
- S72.415RNondisplaced unspecified condyle fracture of lower end of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
- S72.415SNondisplaced unspecified condyle fracture of lower end of left femur, sequela