S72.416A (Nondisplaced unspecified condyle fracture of lower end of unspecified femur, initial encounter for closed fracture)
compared with
S72.416D (Nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for closed fracture with routine healing),
from the official CMS tabular data. S72.416A and S72.416D code the same injury at a different phase of treatment.
Nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for closed fracture with routine healing
Same underlying diagnosis, different encounter phase.
The 7th character records the phase of care for the encounter being coded, so a single encounter takes one of these characters, not several. Review whether both phases belong on the same episode of care.
Source: ICD-10-CM Official Guidelines, Section I.C.19.a
Can these codes be reported together?
Same injury, other encounter phase. S72.416A and S72.416D code the same injury at a different phase of treatment, set by the 7th character.
The 7th character records the type of care given at the encounter being coded (ICD-10-CM Official Guidelines, Section I.C.19.a), so one encounter takes one of these, not both.
S00-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)
Definition
Nondisplaced unspecified condyle fracture of lower end of unspecified femur, initial encounter for closed fracture is a billable ICD-10-CM diagnosis code (S72.416A).
Nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for closed fracture with routine healing is a billable ICD-10-CM diagnosis code (S72.416D).
7th character
The appropriate 7th character is to be added to all codes from category S72
The appropriate 7th character is to be added to all codes from category S72