S72.425B: Nondisplaced fracture of lateral condyle of left femur, initial encounter for open fracture type I or II
S72.425B is a billable, specific ICD-10-CM code for nondisplaced fracture of lateral condyle of left femur, initial encounter for open fracture type i or ii. It is valid for submission on a claim.
Check S72.425B with the rest of the claim: free scrubber7th 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 S72.425B
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S72.425B
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 S72.425B
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
S72.425B 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
S72.425B is named in 7 Medicare coverage policies: 7 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
- A56900Billing and Coding: Immunizations
- A57311Billing and Coding: Physical Therapy - Home Health
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S72.425
- S72.425ANondisplaced fracture of lateral condyle of left femur, initial encounter for closed fracture
- S72.425CNondisplaced fracture of lateral condyle of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.425DNondisplaced fracture of lateral condyle of left femur, subsequent encounter for closed fracture with routine healing
- S72.425ENondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type I or II with routine healing
- S72.425FNondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
- S72.425GNondisplaced fracture of lateral condyle of left femur, subsequent encounter for closed fracture with delayed healing
- S72.425HNondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type I or II with delayed healing
- S72.425JNondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
- S72.425KNondisplaced fracture of lateral condyle of left femur, subsequent encounter for closed fracture with nonunion
- S72.425MNondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type I or II with nonunion
- S72.425NNondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
- S72.425PNondisplaced fracture of lateral condyle of left femur, subsequent encounter for closed fracture with malunion
- S72.425QNondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type I or II with malunion
- S72.425RNondisplaced fracture of lateral condyle of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
- S72.425SNondisplaced fracture of lateral condyle of left femur, sequela