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S72.01 vs S72.92XH

S72.01 (Unspecified intracapsular fracture of femur) compared with S72.92XH (Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing), from the official CMS tabular data.

Summary

These codes should not be reported together because S72.92XH’s tabular entry lists S72.01 under Excludes1.

Official rule
What is different?

The conditions named and billing status.S72.01 is “Unspecified intracapsular fracture of femur”; S72.92XH is “Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing”. S72.01 is a non-billable header; S72.92XH is billable.

Registry fact

Can these codes be reported together?

No.S72.92XH’s entry carries an Excludes1 note covering S72.01: “fracture of hip NOS (S72.00-, S72.01-)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.S72.92XH’s tabular entry: “fracture of hip NOS (S72.00-, S72.01-)”. The note covers S72.01.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. S72.01 carries 9 Excludes2 notes and S72.92XH carries 7 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

No.Both titles are unspecified forms within category S72, and neither is a subdivision of the other.

Registry fact

Is one a parent or header code?

One is a header.S72.01 is a non-billable header, but S72.92XH is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Conflict

Excludes1 conflict

S72.92XH
Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing
S72.01
Unspecified intracapsular fracture of femur

What we found

No — do not report together.S72.92XH carries an Excludes1 note covering S72.01: “fracture of hip NOS (S72.00-, S72.01-)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions cannot occur together, so the pair should not be reported for the same encounter. The sole exception is when the conditions are documented as unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

S72.01Unspecified intracapsular fracture of femurS72.92XHUnspecified fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing
Billing statusNon-billable header

Report instead: S72.011A, S72.011B, S72.011C, S72.011D, S72.011E

Billable
ClassificationS00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)
DefinitionUnspecified intracapsular fracture of femur is a non-billable ICD-10-CM category code (S72.01).Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing is a billable ICD-10-CM diagnosis code (S72.92XH).
7th characterThe appropriate 7th character is to be added to all codes from category S72The appropriate 7th character is to be added to all codes from category S72
Includes
Subcapital fracture of femur
Excludes1
traumatic amputation of hip and thigh (S78.-)
fracture of hip NOS (S72.00-, S72.01-)
traumatic amputation of hip and thigh (S78.-)
Excludes2
physeal fracture of lower end of femur (S79.1-)
physeal fracture of upper end of femur (S79.0-)
fracture of lower leg and ankle (S82.-)
fracture of foot (S92.-)
periprosthetic fracture of prosthetic implant of hip (M97.0-)
burns and corrosions (T20-T32)
frostbite (T33-T34)
snake bite (T63.0-)
venomous insect bite or sting (T63.4-)
fracture of lower leg and ankle (S82.-)
fracture of foot (S92.-)
periprosthetic fracture of prosthetic implant of hip (M97.0-)
burns and corrosions (T20-T32)
frostbite (T33-T34)
snake bite (T63.0-)
venomous insect bite or sting (T63.4-)

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

Derived from the official CMS ICD-10-CM tabular data (FY2026). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources