S72.499C

S72.499C: Other fracture of lower end of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC

Billable / specific codeICD-10-CM

S72.499C is a billable, specific ICD-10-CM code for other fracture of lower end of unspecified femur, initial encounter for open fracture type iiia, iiib, or iiic. It is valid for submission on a claim.

Check S72.499C with the rest of the claim: free scrubber

7th 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 S72.499C

A category’s note binds every code beneath it.

Written on S72: Fracture of femur

traumatic amputation of hip and thigh (S78.-)

Excludes2 inherited from the categories above S72.499C

Not part of this code, but both may be coded when both are present.

Written on S72.4: Fracture of lower end of femur

fracture of shaft of femur (S72.3-)
physeal fracture of lower end of femur (S79.1-)

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 S72.499C

Their own Excludes1 notes name this code, so the conflict is not listed above.

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

Risk adjustment

S72.499C 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.

Code history

Unchanged in every release from FY2024 to FY2027.