How to code a hip fracture in ICD-10-CM, step by step

Which codes count as a hip fracture in ICD-10-CM?

ICD-10-CM has no category named “hip fracture”. In the Alphabetic Index, the entry Fracture, traumatic › hip is only a cross-reference: “see Fracture, femur, neck”. That leads to Fracture, traumatic › femur, femoral › upper end › neck and subcategory S72.00-, whose Tabular inclusion terms include “Fracture of hip NOS”. In practice a hip fracture falls in one of three subcategories of category S72-: S72.0- (head and neck), S72.1- (pertrochanteric) and S72.2- (subtrochanteric).

The hip fracture code list shows every code in these subcategories. This post covers the order of decisions that leads to the right one.

What do the Official Guidelines say about coding a fracture?

Section I.C.19.c of the FY2027 Official Guidelines sets two defaults for every traumatic fracture code, including S72:

“A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced.”

The same two defaults appear as notes at the top of category S72 in the Tabular List. Section I.C.19.c.1 then ties the 7th character to active treatment rather than to the visit number:

“Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.”

“Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.”

How do you build a hip fracture code, step by step?

Step 1: Name the site on the upper femur

The fracture site chooses the S72 subcategory, and it is the one element with no default other than an unspecified code. A record that says only “hip fracture” indexes to S72.00-, fracture of unspecified part of neck of femur. When the provider’s documentation names a more specific site, code that site. If it does not, a query is better than settling for S72.00- (see when unspecified codes are acceptable).

Section I.B.14 lists laterality among the details that may come from other clinicians’ documentation. Fracture site, displacement and open or closed status are not on that list, so they come from the patient’s provider.

Step 2: Decide between displaced and nondisplaced

The Alphabetic Index builds the displaced default into its structure. Intertrochanteric, midcervical, base of neck, subtrochanteric and the trochanter entries each carry the nonessential modifier “(displaced)”, with a separate “nondisplaced” subterm below. So “intertrochanteric fracture, right femur” with nothing said about displacement is S72.141- (displaced), not S72.144- (nondisplaced). Some subcategories, such as S72.00- and S72.01-, are not split by displacement, so this step does not apply to them.

Step 3: Record the side

The side sits in the sixth character in S72.0- and S72.1- and in the fifth in S72.2-. Where there is a displacement axis, the same character carries both facts. In S72.14-, 1 and 2 are displaced right and left, 4 and 5 are nondisplaced right and left, and 3 and 6 are the unspecified-side codes. Read the full code description rather than assuming a digit. Section I.B.13 governs a missing side:

“When laterality is not documented by the patient’s provider, code assignment for the affected side may be based on medical record documentation from other clinicians. If there is conflicting medical record documentation regarding the affected side, the patient’s provider should be queried for clarification. Codes for “unspecified” side should rarely be used, such as when the documentation in the record is insufficient to determine the affected side and it is not possible to obtain clarification.”

Step 4: Choose the 7th character

Every code in category S72 requires a 7th character, and S72 defines 16 of them. Each one records two facts at once: the fracture type (closed or open, with open fractures graded by the Gustilo classification) and the stage of care.

Codes in S72.2- are only five characters long, so the placeholder X fills the sixth position: S72.21XA is valid and S72.21A is not. The 7th characters guide explains the placeholder rule. When an open fracture has no documented Gustilo type, section I.C.19.c.1 settles it:

“When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q).”

What do worked hip fracture examples look like?

When does a hip fracture go to M80 instead of S72?

“A code from category M80, not a traumatic fracture code, should be used for any patient with known osteoporosis who suffers a fracture, even if the patient had a minor fall or trauma, if that fall or trauma would not usually break a normal, healthy bone.”

M80 codes identify the site of the fracture, not the osteoporosis (section I.C.13.d). For the hip, subcategory M80.05- carries the inclusion term “Age-related osteoporosis with current pathological fracture of hip”. Category M80 uses 7th characters A, D, G, K, P, S, with no open or closed axis. Whether the trauma would have broken a healthy bone is a clinical question. When the record documents osteoporosis but is silent on it, a provider query settles the choice between M80 and S72. The osteoporosis code page lists the M80 and M81 Index entries.

How is a fracture around a hip prosthesis coded?

A fracture around an internal hip prosthesis is indexed at Fracture, traumatic › periprosthetic, around internal prosthetic joint › hip, which leads to M97.0- (for example M97.01XA for the right hip). Category S72 lists periprosthetic fracture of the hip (M97.0-) as an Excludes2, which allows both codes when both conditions are present (see Excludes1 vs Excludes2). Category M97 carries a code-first note for “the specific type and cause of fracture, such as traumatic or pathological”, if known. M97 uses only A, D, S.

Two nearby codes are easy to confuse. M96.66- is a fracture of the femur following insertion of an orthopedic implant, joint prosthesis or bone plate. Its parent M96.6- includes intraoperative fracture during insertion, in line with section I.C.19.b.3, which bars chapter 19 injury codes for injuries caused by medical intervention. A break in the prosthesis itself is T84.01- (broken internal joint prosthesis), which M97 lists as an Excludes2.

Which hip fracture coding errors does this sequence prevent?

• Switching to D because a new provider sees the patient. Section I.C.19.a bases the 7th character on whether active treatment is under way, not on whether the provider is new.
• Using D for a patient who delayed seeking care. Section I.C.19.c.1 keeps the initial-encounter character for a delayed presentation.
• Using an aftercare Z code for a healing traumatic fracture. Category Z47- has an Excludes1 note: “aftercare for healing fracture-code to fracture with 7th character D”. The guideline says the same:

“The aftercare Z codes should not be used for aftercare for traumatic fractures. For aftercare of a traumatic fracture, assign the acute fracture code with the appropriate 7th character.”

• Coding a surgical complication with the fracture code. Section I.C.19.c.1 sends complications of surgical fracture repair during the healing phase to complication codes. Nonunion and malunion of the fracture itself stay on the S72 code, with K, M or N for nonunion and P, Q or R for malunion.
• Coding a physeal (growth plate) fracture to S72.0-. S72.0- has an Excludes2 note for physeal fracture of the upper end of the femur (S79.0-). Section I.C.19.c.3 says to assign only the physeal fracture code.

What should you check before submitting a hip fracture code?

• The code has seven characters, with X in the sixth position for any S72.2- code.
• Displacement and open or closed status come from the provider’s documentation, or from the I.C.19.c defaults when the provider is silent.
• The side matches the record. An unspecified-side code is used only when no documentation states the side and clarification cannot be obtained.
• The 7th character reflects active treatment versus the healing phase, not the visit count.
• If osteoporosis is documented, M80.05- was considered. If a hip prosthesis is present, M97.0- was considered.
• Any external cause code from chapter 20 is never sequenced first-listed or principal (section I.C.20), and it carries its own 7th character for each encounter at which the injury is treated (section I.C.20.a.2). Section I.C.20 states there is no national requirement to report external cause codes.