ICD-10 Coding for Distal Femur Fracture(S72.401A, M97.01XA)
Complete ICD-10-CM coding and documentation guide for Distal Femur Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Distal Femur Fracture
S72.4-Primary Range
Fracture of lower end of femur
This range includes all codes related to fractures of the distal femur, specifying laterality and fracture type.
Periprosthetic fracture around internal prosthetic joint
Used for coding periprosthetic fractures, often in conjunction with primary 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 |
|---|---|---|---|
| S72.401A | Unspecified fracture of lower end of right femur, initial encounter | Use when the fracture is unspecified but confirmed on the right distal femur. |
|
| M97.01XA | Periprosthetic fracture around internal prosthetic right hip joint, initial encounter | Use in conjunction with primary fracture codes for periprosthetic fractures. |
|
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 distal femur fracture
Essential facts and insights about Distal Femur Fracture
Primary ICD-10-CM Codes for distal femur fracture
Decision Criteria
clinical Criteria
- Presence of fracture on imaging
documentation Criteria
- Documentation of right femur involvement
Applicable To
- Unspecified fracture of right distal femur
Excludes
- Pathological fracture (M84.4-)
Clinical Validation Requirements
- Radiographic evidence of fracture
- Documentation of initial encounter
Code-Specific Risks
- Lack of specificity may lead to reimbursement issues.
Coding Notes
- Ensure laterality and encounter type are documented.
M97.01XA - Periprosthetic fracture around internal prosthetic right hip joint, initial encounter
Use in conjunction with primary fracture codes for periprosthetic fractures.
Applicable To
- Periprosthetic fracture of right hip
Excludes
- Non-periprosthetic fractures
Clinical Validation Requirements
- Evidence of fracture around prosthetic joint
- Initial encounter documentation
Coding Notes
Ensure correct sequencing with primary fracture codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Distal Femur Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S72.401A.
Impact
Clinical: Potential for incorrect treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Denials or reduced reimbursement due to unspecified coding.
Mitigation Strategy
Always document laterality in the clinical note., Use templates that prompt for laterality.
Impact
Reimbursement: Denials due to incorrect code sequencing., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always sequence the primary fracture code before the periprosthetic code.
Impact
High risk of audit if periprosthetic codes are not sequenced correctly.
Mitigation Strategy
Regular training on coding guidelines and sequencing rules.
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 Distal Femur Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Distal Femur Fracture
Use these documentation templates to ensure complete and accurate documentation for Distal Femur Fracture. These templates include all required elements for proper coding and billing.
Orthopedic evaluation of distal femur fracture
Specialty: OrthopedicsRequired Elements
- Anatomical location
- Fracture type
- Laterality
- Mechanism of injury
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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