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.
7th 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
These are not written on S72.425B, but they bind it: a note on a category applies to every code beneath it. Billing S72.425B with anything listed here is a denial.
Excludes2 inherited from the categories above S72.425B
Also inherited, and the opposite of Excludes1: these conditions are not part of S72.425B, but a patient can have both, so you may code both.
Written on S72.4 — Fracture of lower end of femur
Other codes that can never be billed with S72.425B
These codes carry an Excludes1 note pointing at S72.425B. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S72.425B alone.
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.
Medicare coverage
S72.425B is named in 8 Medicare coverage policies — 8 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52465Knee Orthoses - Policy Article
- A52465Knee Orthoses - Policy Article
- A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
- A56900Billing and Coding: Immunizations
Code history
S72.425B 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 S72.425. If S72.425B is not quite right, the correct code is usually one of these.
- 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
Questions about S72.425B
- Is S72.425B a billable ICD-10-CM code?
- Yes. S72.425B is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S72.425B 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 S72.425B?
- S72.425B 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 S72.425B (S72) and apply to it just the same.