Is S72.91XA a billable ICD-10-CM code?

Yes. S72.91XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S72.91XA 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 S72.91XA?

S72.91XA 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 S72.91XA (S72.9, S72) and apply to it just the same.

S72.91XA

S72.91XA — Unspecified fracture of right femur, initial encounter for closed fracture

Billable / specific codeICD-10-CMright

S72.91XA is a billable, specific ICD-10-CM code for unspecified fracture of right femur, initial encounter for closed fracture. It is valid for submission on a claim.

7th 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 S72.91XA

These are not written on S72.91XA, but they bind it: a note on a category applies to every code beneath it. Billing S72.91XA with anything listed here is a denial.

Written on S72.9 — Unspecified fracture of femur

fracture of hip NOS (S72.00-, S72.01-)

Written on S72 — Fracture of femur

traumatic amputation of hip and thigh (S78.-)

Excludes2 inherited from the categories above S72.91XA

Also inherited, and the opposite of Excludes1: these conditions are not part of S72.91XA, but a patient can have both, so you may code both.

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 S72.91XA

These codes carry an Excludes1 note pointing at S72.91XA. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S72.91XA alone.

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

Risk adjustment

S72.91XA 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

S72.91XA is named in 6 Medicare coverage policies — 6 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
A57683Billing and Coding: Total Hip Arthroplasty
A57685Billing and Coding: Total Knee Arthroplasty

Code history

S72.91XA 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 S72.91. If S72.91XA is not quite right, the correct code is usually one of these.

Questions about S72.91XA

Is S72.91XA a billable ICD-10-CM code?: Yes. S72.91XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S72.91XA 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 S72.91XA?: S72.91XA 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 S72.91XA (S72.9, S72) and apply to it just the same.