S72.099B — Other fracture of head and neck of unspecified femur, initial encounter for open fracture type I or II
Is S72.099B billable?
Yes, but S72.099B will trip a Medicare edit. S72.099B is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S72.099B 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.
S72.099B at a glance
| Code | S72.099B |
|---|---|
| Description | Other fracture of head and neck of unspecified femur, initial encounter for open fracture type I or II |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "B" | initial encounter for open fracture type I or II |
What does the 7th character "B" mean in S72.099B?
In S72.099B, the 7th character B means initial encounter for open fracture type I or II. The 7th character is required for S72.099B to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS72.099A
- Binitial encounter for open fracture type I or IIS72.099B
- Cinitial encounter for open fracture type IIIA, IIIB, or IIICS72.099C
- Dsubsequent encounter for closed fracture with routine healingS72.099D
- Esubsequent encounter for open fracture type I or II with routine healingS72.099E
- Fsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healingS72.099F
- Gsubsequent encounter for closed fracture with delayed healingS72.099G
- Hsubsequent encounter for open fracture type I or II with delayed healingS72.099H
- Jsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healingS72.099J
- Ksubsequent encounter for closed fracture with nonunionS72.099K
- Msubsequent encounter for open fracture type I or II with nonunionS72.099M
- Nsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunionS72.099N
- Psubsequent encounter for closed fracture with malunionS72.099P
- Qsubsequent encounter for open fracture type I or II with malunionS72.099Q
- Rsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunionS72.099R
- SsequelaS72.099S
What Medicare edits apply to S72.099B?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S72.099B 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 S72.099B group to?
S72.099B 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, S72.099B 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 S72.099B listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S72.09, the nearest indexed parent of S72.099B. Use them to find the family, then select the specific code.
- Fracture, traumatic › femur, femoral › upper end › head › specified NEC (abduction) (adduction) (separation)
- Fracture, traumatic › femur, femoral › upper end › neck › specified NEC (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S72
The conditions below can never be reported together with S72.099B 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 S72.099B to fully describe the condition. S72.099B 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 S72.099B, but a patient may have both at the same time. When documentation supports it, S72.099B and the excluded code may both be reported.
Excludes2 — not included here — inherited from S70-S79
The conditions below are not part of S72.099B, but a patient may have both at the same time. When documentation supports it, S72.099B and the excluded code may both be reported.
Excludes2 — not included here — inherited from S72
The conditions below are not part of S72.099B, but a patient may have both at the same time. When documentation supports it, S72.099B and the excluded code may both be reported.
Excludes2 — not included here — inherited from S72.0
The conditions below are not part of S72.099B, but a patient may have both at the same time. When documentation supports it, S72.099B and the excluded code may both be reported.
How long has S72.099B existed?
S72.099B 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.