2026 ICD-10-CM Diagnosis Code S72.416RNondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.416R is a billable ICD-10-CM diagnosis code for nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion. The 7th character R reports a subsequent encounter for an open fracture (type IIIA, IIIB, or IIIC) with malunion. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 564 through 566. The code is flagged as an unspecified code, since codes identifying laterality exist in the same family and exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of lower limb (except hip), subsequent encounter.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for S72.416R.
Present on Admission (POA)Billing
S72.416R is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.
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 2026, published by CMS and the National Center for Health Statistics.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
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 S72.416R to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S72.416ROverview
Is S72.416R a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character R in S72.416R mean?
The final character R reports a subsequent encounter for an open fracture (type IIIA, IIIB, or IIIC) with malunion, in this case involving the nondisplaced unspecified condyle fracture of lower end of unspecified femur.
What MS-DRG does S72.416R group to?
When nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion is the principal diagnosis on an inpatient stay, it groups to MS-DRG 564, 565, 566, with relative weights from 0.7493 to 1.5436 depending on complications. Higher weights mean higher Medicare reimbursement.
Is S72.416R exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion on inpatient claims.
What is the ICD-9 equivalent of S72.416R?
Under the General Equivalence Mappings, nondisplaced unspecified condyle fracture of lower end of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion converts to ICD-9-CM 733.81 (malunion of fracture). The mapping is approximate, so confirm the match fits the documentation.
Footnotes
[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.
