S72.91XC: Unspecified fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.91XC is a billable, specific ICD-10-CM code for unspecified fracture of right femur, initial encounter for open fracture type iiia, iiib, or iiic. It is valid for submission on a claim.
Check S72.91XC with the rest of the claim: free scrubber7th 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 S72.91XC
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S72.91XC
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with S72.91XC
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
S72.91XC 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
S72.91XC is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52465Knee Orthoses - Policy Article
- A57683Billing and Coding: Total Hip Arthroplasty
- A57685Billing and Coding: Total Knee Arthroplasty
- A57765Billing and Coding: Major Joint Replacement (Hip and Knee)
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S72.91
- S72.91XAUnspecified fracture of right femur, initial encounter for closed fracture
- S72.91XBUnspecified fracture of right femur, initial encounter for open fracture type I or II
- S72.91XDUnspecified fracture of right femur, subsequent encounter for closed fracture with routine healing
- S72.91XEUnspecified fracture of right femur, subsequent encounter for open fracture type I or II with routine healing
- S72.91XFUnspecified fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
- S72.91XGUnspecified fracture of right femur, subsequent encounter for closed fracture with delayed healing
- S72.91XHUnspecified fracture of right femur, subsequent encounter for open fracture type I or II with delayed healing
- S72.91XJUnspecified fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
- S72.91XKUnspecified fracture of right femur, subsequent encounter for closed fracture with nonunion
- S72.91XMUnspecified fracture of right femur, subsequent encounter for open fracture type I or II with nonunion
- S72.91XNUnspecified fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
- S72.91XPUnspecified fracture of right femur, subsequent encounter for closed fracture with malunion
- S72.91XQUnspecified fracture of right femur, subsequent encounter for open fracture type I or II with malunion
- S72.91XRUnspecified fracture of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
- S72.91XSUnspecified fracture of right femur, sequela