ICD-10 Coding for Fracture of Hip(S72.001A, M80.051A)
Complete ICD-10-CM coding and documentation guide for Fracture of Hip. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fracture of Hip
S72.0-S72.9Primary Range
Fracture of femur
This range includes traumatic fractures of the femur, which are common in hip fractures.
Osteoporosis with current pathological fracture
This range is used for pathological fractures due to osteoporosis, often affecting the hip.
Periprosthetic fracture around internal prosthetic joint
This range is used for fractures occurring around prosthetic joints, including the hip.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S72.001A | Fracture of unspecified part of neck of femur, initial encounter for closed fracture | Use for initial encounter of traumatic femoral neck fractures. |
|
| M80.051A | Age-related osteoporosis with current pathological fracture, right femur, initial encounter | Use for pathological fractures due to osteoporosis. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hip fracture
Essential facts and insights about Fracture of Hip
Primary ICD-10-CM Codes for fracture of hip
Decision Criteria
clinical Criteria
- Presence of trauma and fracture on imaging
documentation Criteria
- Specify laterality and encounter type
Applicable To
- Closed fracture of femoral neck
Excludes
- Pathological fracture (M80.-)
Clinical Validation Requirements
- X-ray or MRI showing fracture
- Clinical history of trauma
Code-Specific Risks
- Misclassification as pathological fracture
Coding Notes
- Ensure trauma is documented to differentiate from pathological fractures.
M80.051A - Age-related osteoporosis with current pathological fracture, right femur, initial encounter
Use for pathological fractures due to osteoporosis.
Applicable To
- Pathological fracture due to osteoporosis
Excludes
- Traumatic fracture (S72.-)
Clinical Validation Requirements
- DEXA scan showing osteoporosis
- Absence of trauma
Coding Notes
Ensure osteoporosis is documented as the cause.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fracture of Hip to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S72.001A.
Impact
Clinical: Ambiguity in treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document the side of the fracture.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Verify the presence of trauma and use M80 codes for osteoporosis-related fractures.
Impact
Risk of coding traumatic fractures as pathological.
Mitigation Strategy
Verify trauma history and osteoporosis status.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Fracture of Hip, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of Hip
Use these documentation templates to ensure complete and accurate documentation for Fracture of Hip. These templates include all required elements for proper coding and billing.
Initial encounter for traumatic hip fracture
Specialty: OrthopedicsRequired Elements
- Fracture location
- Fracture type
- Encounter type
- Trauma history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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