ICD-10 Coding for Periprosthetic Femur Fracture(S72.401A, M97.01XA)
Complete ICD-10-CM coding and documentation guide for Periprosthetic Femur Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Periprosthetic Femur Fracture
S72.0-S72.9Primary Range
Fracture of femur
Primary range for traumatic femur fractures, including periprosthetic.
Periprosthetic fracture around internal prosthetic joint
Used as a secondary code to specify the periprosthetic nature of the fracture.
Pathological fracture, not elsewhere classified
Used for pathological fractures involving prosthetic joints.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S72.401A | Unspecified fracture of right femur, initial encounter for closed fracture | Use for initial encounter of a traumatic fracture of the right femur. |
|
| M97.01XA | Periprosthetic fracture around internal prosthetic right hip joint, initial encounter | Use as a secondary code to specify periprosthetic involvement in a fracture. |
|
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 right periprosthetic femur fracture
Essential facts and insights about Periprosthetic Femur Fracture
Primary ICD-10-CM Codes for periprosthetic femur fracture
Decision Criteria
clinical Criteria
- Confirmed traumatic fracture via imaging
documentation Criteria
- Detailed mechanism of injury documented
Applicable To
- Traumatic fracture of femur
Excludes
- Pathological fracture (M84.4-)
Clinical Validation Requirements
- X-ray or CT confirming fracture location
- Clinical history of trauma
Code-Specific Risks
- Incorrect laterality
- Missing encounter type
Coding Notes
- Ensure documentation specifies the traumatic nature and laterality.
M97.01XA - Periprosthetic fracture around internal prosthetic right hip joint, initial encounter
Use as a secondary code to specify periprosthetic involvement in a fracture.
Applicable To
- Fracture around prosthetic joint
Excludes
- Intraoperative fracture (M96.6-)
Clinical Validation Requirements
- Imaging showing fracture around prosthesis
- Documentation of prosthesis type and stability
Coding Notes
Ensure prosthesis details and fracture mechanism are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on same level from slipping, tripping and stumbling
W18.XXXADifferential 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 Periprosthetic Femur Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S72.401A.
Impact
Clinical: Ambiguity in treatment records., Regulatory: Potential for audit issues., Financial: Risk of claim denials.
Mitigation Strategy
Always include laterality in clinical documentation., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Impacts accuracy of medical records.
Mitigation Strategy
Use M97 codes for fractures around prosthetic joints.
Impact
Failure to sequence fracture and periprosthetic codes correctly.
Mitigation Strategy
Educate coders on proper sequencing rules.
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 Periprosthetic Femur Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Periprosthetic Femur Fracture
Use these documentation templates to ensure complete and accurate documentation for Periprosthetic Femur Fracture. These templates include all required elements for proper coding and billing.
Traumatic periprosthetic fracture
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Prosthesis type and stability
- Fracture classification
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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