ICD-10 Coding for Broken Hip(S72.0XXA, M97.01XA)
Complete ICD-10-CM coding and documentation guide for Broken Hip. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Broken Hip
S72.0-S72.2Primary Range
Fractures of the femur, including neck, intertrochanteric, and subtrochanteric regions
These codes cover the most common types of hip fractures encountered in clinical practice.
Periprosthetic fractures around internal prosthetic joints
Used when a fracture occurs around a hip prosthesis.
Pathological fractures, not elsewhere classified
Used for fractures due to underlying conditions like osteoporosis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S72.0XXA | Fracture of femoral neck, initial encounter | Use for traumatic fractures of the femoral neck. |
|
| M97.01XA | Periprosthetic fracture around internal prosthetic joint, initial encounter | Use when a fracture occurs around a hip prosthesis. |
|
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 broken hip
Essential facts and insights about Broken Hip
Primary ICD-10-CM Codes for broken hip
Decision Criteria
clinical Criteria
- Confirmed fracture on imaging
documentation Criteria
- Detailed mechanism of injury
Applicable To
- Displaced femoral neck fracture
- Non-displaced femoral neck fracture
Excludes
- Pathological fracture (M84.4XXA)
Clinical Validation Requirements
- X-ray or MRI confirming femoral neck fracture
- Clinical notes detailing mechanism of injury
Code-Specific Risks
- Incorrect laterality
- Missing 7th character for encounter type
Coding Notes
- Ensure laterality and encounter type are specified.
M97.01XA - Periprosthetic fracture around internal prosthetic joint, initial encounter
Use when a fracture occurs around a hip prosthesis.
Applicable To
- Fracture around hip prosthesis
Clinical Validation Requirements
- Imaging showing fracture around prosthesis
- Surgical notes if applicable
Coding Notes
Ensure the primary fracture code is sequenced first.
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
W00.0XXADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Dislocation of hip joint
S73.0XXADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Broken Hip to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S72.0XXA.
Impact
Clinical: Ambiguity in treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always document laterality in clinical notes.
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Poor data quality for clinical and research purposes.
Mitigation Strategy
Always specify the exact location and laterality of the fracture.
Impact
Use of unspecified codes can trigger audits.
Mitigation Strategy
Ensure detailed documentation and use of specific codes.
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 Broken Hip, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Broken Hip
Use these documentation templates to ensure complete and accurate documentation for Broken Hip. These templates include all required elements for proper coding and billing.
Initial encounter for hip fracture
Specialty: OrthopedicsRequired Elements
- Patient demographics
- Mechanism of injury
- Fracture type and location
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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