ICD-10 Code for Hip Fracture

What is the ICD-10 code for right hip fracture?

The ICD-10-CM code for right hip fracture is S72.001- — Fracture of unspecified part of neck of right femur. S72.001 needs a 7th character for the encounter before it can be billed.

What is the ICD-10 code for left hip fracture?

The ICD-10-CM code for left hip fracture is S72.002- — Fracture of unspecified part of neck of left femur. S72.002 needs a 7th character for the encounter before it can be billed.

Is there an ICD-10 code for bilateral hip fracture?

No. ICD-10-CM has no bilateral code for hip fracture, so bilateral hip fracture is reported with both S72.001- (right) and S72.002- (left).

“If no bilateral code is provided and the condition is bilateral, assign separate codes for both the left and right side.”

When can the unspecified-side code for hip fracture be used?

The unspecified-side code for hip fracture is S72.009- — Fracture of unspecified part of neck of unspecified femur. S72.009 needs a 7th character for the encounter before it can be billed.

“If the side is not identified in the medical record, assign the code for the unspecified side.”

“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.”

Medicare edit: S72.009- is on the Medicare Code Editor’s unspecified-laterality list (edit 20), so expect it to be questioned on a Medicare claim.

Which 7th character does a hip fracture code need?

Every hip fracture code requires a 7th character describing the encounter. For S72.001- the options are:

Not every code accepts every character — the classification restricts some. Check the code’s own page before reporting it.

What changes the hip fracture code?

The Alphabetic Index lists these qualifiers under Fracture, traumatic, femur, femoral, upper end. If the record documents one of them, the code changes. Verify the code in the Tabular List before reporting it.

What else changes the hip fracture code?

If the patient has known osteoporosis and the fracture followed a fall or trauma that would not usually break a healthy bone, it is coded as a pathological fracture from category M80 — for the femur, M80.05- — not from 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.”

What does the Tabular List say about S72.00?

The instructional notes that govern S72.00-, including those it inherits from its category and chapter. An Excludes1 note means the two codes are never reported together.

Conditions related to hip fracture

• ICD-10 code for Hip pain
• ICD-10 code for Hip osteoarthritis
• Every Index entry under Fracture