2027 ICD-10-CM Diagnosis Code S72.045ANondisplaced fracture of base of neck of left femur, initial encounter for closed fracture
ICD-10-CM Codes›S00–T88›S70-S79›S72
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 402
- 7th Character A — Initial Encounter for Closed Fracture
- Not Chronic
S72.045A is a billable ICD-10-CM diagnosis code for nondisplaced fracture of base of neck of left femur, initial encounter for closed fracture. The 7th character A means initial encounter for closed fracture, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 521 through 522, 535 through 536, 791, 793, 963 through 965. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 731 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the neck of the femur (hip), initial encounter.
For Medicare Advantage risk adjustment, S72.045A maps to CMS-HCC Category 402 (Hip Fracture/Dislocation) under the V28 model, adding a risk factor of about 0.467 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Quality Payment Program MeasuresBilling
Medicare quality measures that can apply when S72.045A is part of the patient record.
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older
High Priority: YES
Measure Type: Process
Submission Methods: Claims, Registry
Description: Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication.
Osteoporosis Management in Women Who Had a Fracture
High Priority: NO
Measure Type: Process
Submission Methods: Claims, Registry
Description: The percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the 180 days after the fracture.
Medicare Risk Adjustment (HCC)Billing
S72.045A maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Coding GuidelinesGuidance
The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site, to the level of detail furnished by medical record content.
A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced.
Initial vs. Subsequent Encounter for Fractures
Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) while the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.
Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.
Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.
Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N) or subsequent care with malunion (P, Q, R).
The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q).
Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to S72.045A: its own notes plus those printed at S72.0, S72, block S70-S79, and Chapter 19. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify any retained foreign body, if applicable (Z18.-)
Notes
General instructions on how these codes are used.
- A fracture not indicated as displaced or nondisplaced should be coded to displaced
- A fracture not indicated as open or closed should be coded to closed
- The open fracture designations are based on the Gustilo open fracture classification
- Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
- The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- The appropriate 7th character is to be added to all codes from category S72
- Ainitial encounter for closed fracture this code
- Binitial encounter for open fracture type I or II
- Cinitial encounter for open fracture type IIIA, IIIB, or IIIC
- Dsubsequent encounter for closed fracture with routine healing
- Esubsequent encounter for open fracture type I or II with routine healing
- Fsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
- Gsubsequent encounter for closed fracture with delayed healing
- Hsubsequent encounter for open fracture type I or II with delayed healing
- Jsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
- Ksubsequent encounter for closed fracture with nonunion
- Msubsequent encounter for open fracture type I or II with nonunion
- Nsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
- Psubsequent encounter for closed fracture with malunion
- Qsubsequent encounter for open fracture type I or II with malunion
- Rsubsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
- Ssequela
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name S72.045A, its category, or a range that includes it.
Excludes1 3
These codes carry an Excludes1 note naming S72.045A: they are not reported together with it, unless the two conditions are unrelated.
- M84.3 Stress fracturetraumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-) names S72.-, which includes this code
- M84.4 Pathological fracture, not elsewhere classifiedtraumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-) names S72.-, which includes this code
- S71 Open wound of hip and thighopen fracture of hip and thigh (S72.-) names S72.-, which includes this code
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Femur Fracture
a traumatic or pathologic injury to the femur in which the continuity of the femur is broken.
Patient EducationClinical
Fractures
A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.
The full article covers:
- What is a fracture?
- What are the different types of fractures?
- What causes fractures?
- What are the symptoms of a fracture?
- How are fractures diagnosed?
- What are the treatments for fractures?
- Can fractures be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert S72.045A to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S72.045AOverview
Is S72.045A (Nondisplaced fracture of base of neck of left femur) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report nondisplaced fracture of base of neck of left femur, initial encounter for closed fracture on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character A in S72.045A mean?
The final character A marks the initial encounter: use it while the patient is receiving active treatment for nondisplaced fracture of base of neck of left femur, such as an emergency visit or first evaluation. In this category the CMS Tabular List defines A as "initial encounter for closed fracture".
What MS-DRG does S72.045A group to?
When nondisplaced fracture of base of neck of left femur, initial encounter for closed fracture is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 964, 965, 536, 521, 522, 535, 963, with relative weights from 0.8068 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is S72.045A a CC or MCC?
CMS lists S72.045A as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 731 closely related codes in its exclusion list.
Can S72.045A be reported with a code from S78?
Not as a rule. The Excludes1 note at S72, which applies to S72.045A, lists "traumatic amputation of hip and thigh (S78.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is S72.045A?
S72.045A (nondisplaced fracture of base of neck of left femur, initial encounter for closed fracture) maps to CMS-HCC Category 402 (Hip Fracture/Dislocation), commonly written as HCC 402, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 170 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does S72.045A risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, S72.045A adds a risk adjustment factor of about 0.467 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.089 to 0.570 depending on the payment segment). HCC 402 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 402 category page.
