S72.019C — Unspecified intracapsular fracture of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
Is S72.019C billable?
Yes, but S72.019C will trip a Medicare edit. S72.019C is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S72.019C under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
More specific alternatives
- S72.021CDisplaced fracture of epiphysis (separation) (upper) of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.031CDisplaced midcervical fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.041CDisplaced fracture of base of neck of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.061CDisplaced articular fracture of head of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
- S72.091COther fracture of head and neck of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
S72.019C at a glance
| Code | S72.019C |
|---|---|
| Description | Unspecified intracapsular fracture of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "C" | initial encounter for open fracture type IIIA, IIIB, or IIIC |
What does the 7th character "C" mean in S72.019C?
In S72.019C, the 7th character C means initial encounter for open fracture type IIIA, IIIB, or IIIC. The 7th character is required for S72.019C to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS72.019A
- Binitial encounter for open fracture type I or IIS72.019B
- Cinitial encounter for open fracture type IIIA, IIIB, or IIICS72.019C
- Dsubsequent encounter for closed fracture with routine healingS72.019D
- Esubsequent encounter for open fracture type I or II with routine healingS72.019E
- Fsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healingS72.019F
- Gsubsequent encounter for closed fracture with delayed healingS72.019G
- Hsubsequent encounter for open fracture type I or II with delayed healingS72.019H
- Jsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healingS72.019J
- Ksubsequent encounter for closed fracture with nonunionS72.019K
- Msubsequent encounter for open fracture type I or II with nonunionS72.019M
- Nsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunionS72.019N
- Psubsequent encounter for closed fracture with malunionS72.019P
- Qsubsequent encounter for open fracture type I or II with malunionS72.019Q
- Rsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunionS72.019R
- SsequelaS72.019S
What Medicare edits apply to S72.019C?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S72.019C directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does S72.019C group to?
S72.019C sits in MDC 08 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 521Hip Replacement with Principal Diagnosis of Hip Fracture with MCCsurgical
- 522Hip Replacement with Principal Diagnosis of Hip Fracture without MCCsurgical
As a secondary diagnosis, S72.019C is a major complication or comorbidity (MCC), which can move a stay into a higher-paying DRG. It also carries Hospital-Acquired Condition category 05.
How is S72.019C listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S72.01, the nearest indexed parent of S72.019C. Use them to find the family, then select the specific code.
- Fracture, traumatic › femur, femoral › subcapital (abduction) (adduction) (separation)
- Fracture, traumatic › femur, femoral › upper end › intracapsular (abduction) (adduction) (separation)
- Fracture, traumatic › femur, femoral › upper end › subcapital (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S72
The conditions below can never be reported together with S72.019C on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- traumatic amputation of hip and thigh (S78.-)
Use additional code — inherited from Chapter 19
Report an additional code alongside S72.019C to fully describe the condition. S72.019C is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of S72.019C, but a patient may have both at the same time. When documentation supports it, S72.019C and the excluded code may both be reported.
Excludes2 — not included here — inherited from S70-S79
The conditions below are not part of S72.019C, but a patient may have both at the same time. When documentation supports it, S72.019C and the excluded code may both be reported.
Excludes2 — not included here — inherited from S72
The conditions below are not part of S72.019C, but a patient may have both at the same time. When documentation supports it, S72.019C and the excluded code may both be reported.
Excludes2 — not included here — inherited from S72.0
The conditions below are not part of S72.019C, but a patient may have both at the same time. When documentation supports it, S72.019C and the excluded code may both be reported.
How long has S72.019C existed?
S72.019C has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.