ICD-10 Coding for Proximal Femur Fracture(S72.001A, M84.451A)
Complete ICD-10-CM coding and documentation guide for Proximal Femur Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Proximal Femur Fracture
S72.0-S72.2Primary Range
Fractures of the femur
These codes cover traumatic fractures of the proximal femur, including femoral neck, intertrochanteric, and subtrochanteric fractures.
Pathological fracture in neoplastic disease
This range is used for pathological fractures of the femur due to conditions like osteoporosis or metastatic disease.
Periprosthetic fracture around internal prosthetic joint
Used for fractures occurring around a prosthetic joint, often in conjunction with traumatic fracture codes.
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 | Unspecified fracture of right femoral neck, initial encounter | Use for initial encounter of a traumatic fracture of the right femoral neck. |
|
| M84.451A | Pathological fracture of right femur, initial encounter | Use for initial encounter of a pathological fracture of the right femur 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 right proximal femur fracture
Essential facts and insights about Proximal Femur Fracture
Primary ICD-10-CM Codes for proximal femur fracture
Decision Criteria
clinical Criteria
- Presence of trauma and X-ray confirmation
documentation Criteria
- Detailed description of fracture type and encounter
Applicable To
- Traumatic fracture of right femoral neck
Excludes
- Pathological fracture (M84.45-)
Clinical Validation Requirements
- X-ray confirmation of fracture
- Clinical history of trauma
Code-Specific Risks
- Ensure laterality is documented
- Specify encounter type
Coding Notes
- Ensure documentation specifies whether the fracture is open or closed.
M84.451A - Pathological fracture of right femur, initial encounter
Use for initial encounter of a pathological fracture of the right femur due to osteoporosis.
Applicable To
- Fracture due to osteoporosis
Excludes
- Traumatic fracture (S72.0-S72.2)
Clinical Validation Requirements
- DEXA scan showing osteoporosis
- Lack of significant trauma
Coding Notes
Document the underlying condition causing the fracture.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Periprosthetic fracture around right hip joint, initial encounter
M97.01XADifferential 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 Proximal Femur Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S72.001A.
Impact
Clinical: Leads to vague clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document specific details like laterality and encounter type.
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Always specify the side of the fracture (right or left).
Impact
Using incorrect codes for fracture types can lead to audits.
Mitigation Strategy
Ensure detailed documentation and correct code selection.
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 Proximal Femur Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Proximal Femur Fracture
Use these documentation templates to ensure complete and accurate documentation for Proximal Femur Fracture. These templates include all required elements for proper coding and billing.
Traumatic Femoral Neck Fracture
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Fracture type and location
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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