S79.099A — Other physeal fracture of upper end of unspecified femur, initial encounter for closed fracture
Is S79.099A billable?
Yes, but S79.099A will trip a Medicare edit. S79.099A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S79.099A 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.
S79.099A at a glance
| Code | S79.099A |
|---|---|
| Description | Other physeal fracture of upper end of unspecified femur, initial encounter for closed fracture |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter for closed fracture |
What does the 7th character "A" mean in S79.099A?
In S79.099A, the 7th character A means initial encounter for closed fracture. The 7th character is required for S79.099A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS79.099A
- Dsubsequent encounter for fracture with routine healingS79.099D
- Gsubsequent encounter for fracture with delayed healingS79.099G
- Ksubsequent encounter for fracture with nonunionS79.099K
- Psubsequent encounter for fracture with malunionS79.099P
- SsequelaS79.099S
What Medicare edits apply to S79.099A?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S79.099A 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 S79.099A group to?
S79.099A 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, S79.099A 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 S79.099A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S79.09, the nearest indexed parent of S79.099A. Use them to find the family, then select the specific code.
- Fracture, traumatic › femur, femoral › upper end › physeal › specified NEC (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S79.0
The conditions below can never be reported together with S79.099A on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Use additional code — inherited from Chapter 19
Report an additional code alongside S79.099A to fully describe the condition. S79.099A 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 S79.099A, but a patient may have both at the same time. When documentation supports it, S79.099A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S70-S79
The conditions below are not part of S79.099A, but a patient may have both at the same time. When documentation supports it, S79.099A and the excluded code may both be reported.
How long has S79.099A existed?
S79.099A 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.