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S72.92XB ICD-10-CM Code: Unspecified fracture of left femur, initial encounter for open fracture type I or II

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
2 Excludes1 · 7 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 170

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 533 — FRACTURES OF FEMUR WITH MCC (MDC 08)
  • MS-DRG 534 — FRACTURES OF FEMUR WITHOUT MCC (MDC 08)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)
  • MS-DRG 964 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC (MDC 24)
  • MS-DRG 965 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC (MDC 24)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 402 — Hip Fracture/Dislocation

Other models: CMS-HCC V22 HCC 170

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Code Overview

Unspecified fracture of left femur, initial encounter for open fracture type I or II is a billable ICD-10-CM diagnosis code (S72.92XB).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for S72.92XB in the official ICD-10-CM tabular list.

Notes without a marker are published on S72.92XB itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

7th Character Guide

"The appropriate 7th character is to be added to all codes from category S72"

  • A — initial encounter for closed fracture
  • B — initial encounter for open fracture type I or II (this page’s code)
  • C — initial encounter for open fracture type IIIA, IIIB, or IIIC
  • D — subsequent encounter for closed fracture with routine healing
  • E — subsequent encounter for open fracture type I or II with routine healing
  • F — subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
  • G — subsequent encounter for closed fracture with delayed healing
  • H — subsequent encounter for open fracture type I or II with delayed healing
  • J — subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
  • K — subsequent encounter for closed fracture with nonunion
  • M — subsequent encounter for open fracture type I or II with nonunion
  • N — subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
  • P — subsequent encounter for closed fracture with malunion
  • Q — subsequent encounter for open fracture type I or II with malunion
  • R — subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
  • S — sequela

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

S72.92XA, S72.92XB, S72.92XC, S72.92XD, S72.92XE, S72.92XF, S72.92XG, S72.92XH, S72.92XJ, S72.92XK, S72.92XM, S72.92XN, S72.92XP, S72.92XQ, S72.92XR, S72.92XS

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Official Coding Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

c. Coding of Traumatic Fractures The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site in accordance with both the provisions within categories S02, S12, S22, S32, S42, S49, S52, S59, S62, S72, S79, S82, S89, S92 and the level of detail furnished by medical record content.

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Unspecified fracture of left femur, initial encounter for open fracture type I or II

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
  3. 2 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  4. 7 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

Other codes that name S72.92XB or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 3 Excludes1 notes across 2 chapters: M84.3 — Stress fracture (via S72.-), M84.4 — Pathological fracture, not elsewhere classified (via S72.-), S71 — Open wound of hip and thigh (via S72.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2026)

MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 814 clinically related codes on its CMS exclusion list. Does not count toward severity when the stay groups to DRGs 957-959 (Other O.R. Procedures for Multiple Significant Trauma); DRGs 963-965 (Other Multiple Significant Trauma).

Potential MS-DRG participation — not a DRG assignment.

Named in the grouper logic of 7 MS-DRGs: DRG 533 (MDC 08), DRG 534 (MDC 08), DRG 791 (MDC 15), DRG 793 (MDC 15), DRG 963 (MDC 24), DRG 964 (MDC 24), DRG 965 (MDC 24).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INJ005 — Fracture of the lower limb (except hip), initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

S72.90XB — Unspecified fracture of unspecified femur, initial encounter for open fracture type I or II (unspecified)Compare S72.92XB vs S72.90XB →, S72.91XB — Unspecified fracture of right femur, initial encounter for open fracture type I or II (right)Compare S72.92XB vs S72.91XB →

Same injury, other encounter phase

Same injury, coded at a different phase of treatment via the 7th character.

S72.92XA — Unspecified fracture of left femur, initial encounter for closed fractureCompare S72.92XB vs S72.92XA →, S72.92XC — Unspecified fracture of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC, S72.92XD — Unspecified fracture of left femur, subsequent encounter for closed fracture with routine healing, S72.92XE — Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with routine healing, S72.92XF — Unspecified fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing, S72.92XG — Unspecified fracture of left femur, subsequent encounter for closed fracture with delayed healing, S72.92XH — Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with delayed healing, S72.92XJ — Unspecified fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing, S72.92XK — Unspecified fracture of left femur, subsequent encounter for closed fracture with nonunion, S72.92XM — Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with nonunion, S72.92XN — Unspecified fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion, S72.92XP — Unspecified fracture of left femur, subsequent encounter for closed fracture with malunion, S72.92XQ — Unspecified fracture of left femur, subsequent encounter for open fracture type I or II with malunion, S72.92XR — Unspecified fracture of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion, S72.92XS — Unspecified fracture of left femur, sequela

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Hip Fracture/Dislocation) for risk-adjusted payment.

S72.8X9A — Other fracture of unspecified femur, initial encounter for closed fracture, S72.8X9B — Other fracture of unspecified femur, initial encounter for open fracture type I or II, S72.8X9C — Other fracture of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC, S72.90XA — Unspecified fracture of unspecified femur, initial encounter for closed fracture, S72.90XB — Unspecified fracture of unspecified femur, initial encounter for open fracture type I or II, S72.90XC — Unspecified fracture of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC, S72.91XA — Unspecified fracture of right femur, initial encounter for closed fracture, S72.91XB — Unspecified fracture of right femur, initial encounter for open fracture type I or II, S72.91XC — Unspecified fracture of right femur, initial encounter for open fracture type IIIA, IIIB, or IIIC, S72.92XA — Unspecified fracture of left femur, initial encounter for closed fracture, S72.92XC — Unspecified fracture of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC, S73.001A — Unspecified subluxation of right hip, initial encounter, S73.002A — Unspecified subluxation of left hip, initial encounter, S73.003A — Unspecified subluxation of unspecified hip, initial encounter, S73.004A — Unspecified dislocation of right hip, initial encounter, S73.005A — Unspecified dislocation of left hip, initial encounter, S73.006A — Unspecified dislocation of unspecified hip, initial encounter, S73.011A — Posterior subluxation of right hip, initial encounter, S73.012A — Posterior subluxation of left hip, initial encounter, S73.013A — Posterior subluxation of unspecified hip, initial encounter, +708 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Fracture of the lower limb (except hip), initial encounter).

+1430 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of S72.92XB in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

Referenced by Excludes1 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 402 — Hip Fracture/Dislocation [CMS-HCC]

MS-DRG Grouper

MDC crossing

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]

Frequently Asked Questions (FAQ) & Clinical Guidance

Does S72.92XB require a 7th character?

Yes. The appropriate 7th character is to be added to all codes from category S72.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S72.92XB in its code family, with their registry titles.

View all codes in the S72 family