ICD-10 S72
Non-Billable HeaderFracture of femur
About ICD-10-CM S72
ICD-10-CM code S72 represents Fracture of femur. This is a non-billable header code in the Injury, Poisoning, and External Causes chapter (block S72). The 2026 edition of ICD-10-CM S72 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for S72
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Injury codes require a 7th character: A (initial encounter, active treatment), D (subsequent, healing/recovery), S (sequela, late effect of original injury). Codes with fewer than 6 characters need the placeholder X to bring them to 6 characters before adding the 7th. Wrong or missing 7th character is the #1 cause of injury claim denials.
Type 1 Excludes
Pure excludes, these codes can never be coded together with S72. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- traumatic amputation of hip and thigh (S78.-)
Type 2 Excludes
Not included here, the excluded code is not part of S72, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- fracture of lower leg and ankle (S82.-)
- fracture of foot (S92.-)
- periprosthetic fracture of prosthetic implant of hip (M97.0-)
Coding Notes
Seven Chr Def
- initial encounter for open fracture NOS
Seven Chr Note
- The appropriate 7th character is to be added to all codes from category S72
Medicare LCD Coverage for S72
Local Coverage Determinations (LCDs) from CMS MACs that list S72 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing S72.
1 Aetna
CPT Codes Commonly Billed with S72
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To S72
Other codes in section S70-S79 (Injuries to the hip and thigh).
ICD-10 S72, Billing FAQ
Is ICD-10 code S72 billable? +
No, S72 is a non-billable header code. Use a more specific child code from block S72 when submitting claims.
What codes are Type 1 Excludes for S72? +
Type 1 Excludes (never code together with S72): traumatic amputation of hip and thigh (S78.-)
What codes are Type 2 Excludes for S72? +
Type 2 Excludes (may be coded together when both conditions exist): fracture of lower leg and ankle (S82.-); fracture of foot (S92.-); periprosthetic fracture of prosthetic implant of hip (M97.0-)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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