ICD-10 Hip Fracture Codes 2027: S72 Coding, Seventh Characters, and Aftercare for Orthopaedic Practices

Hip fractures are coded in ICD-10-CM category S72 (fracture of femur), primarily in three subcategories: S72.0- for femoral neck and head fractures, S72.1- for pertrochanteric fractures including intertrochanteric (S72.14-), and S72.2- for subtrochanteric fractures (S72.21X- through S72.26X-). A complete code requires the fracture location, displaced versus nondisplaced status, laterality, and a seventh character that identifies the encounter type and healing status, such as A for the initial encounter of a closed fracture or D for a subsequent encounter with routine healing. Fractures caused by disease are coded elsewhere, for example M80.05- for an osteoporotic fracture of the femur, and fractures around an existing hip prosthesis use M97.0-.

Hip fracture coding looks straightforward until the claims start coming back. Wrong seventh characters on follow-up visits, osteoporotic fractures coded as traumatic, aftercare coded with Z codes instead of the fracture code, and unspecified sites that do not support the procedure performed are all common in orthopaedic practices. This reference walks through the code structure, the official guidelines that matter, the CPT pairings, and the documentation that keeps hip fracture claims clean.

Why Hip Fracture Coding Deserves Attention in 2027

According to the CDC, more than 300,000 older adults are hospitalized for hip fractures in the U.S. each year, and most result from falls. For orthopaedic groups with trauma call coverage, hip fractures are a steady, high-acuity line of surgical volume, and every case generates a surgical claim plus a 90-day global period of follow-up visits that must be coded correctly.

The financial stakes are also rising at the episode level. CMS's Transforming Episode Accountability Model (TEAM), a mandatory model for selected hospitals that began January 1, 2026, includes surgical hip and femur fracture treatment as one of its episode categories, along with lower extremity joint replacement and spinal fusion. In episode-based models, accurate diagnosis coding influences risk adjustment and how performance is measured, so orthopaedic surgeons working with participating hospitals have more reason than ever to code fractures precisely.

How ICD-10-CM Hip Fracture Codes Are Built

Every S72 code has up to seven characters. Understanding each position makes the code set much easier to use.

• Characters 1 to 3 (S72): Fracture of femur
• Character 4: Anatomic region, such as 0 for head and neck, 1 for pertrochanteric, and 2 for subtrochanteric
• Character 5: Specific fracture site within the region, such as midcervical or intertrochanteric
• Character 6: Laterality and displacement
• Character 7: Encounter type and healing status

Laterality and Displacement (Character 6)

For most S72 hip fracture subcategories, the sixth character follows this pattern:

• 1: Displaced, right femur
• 2: Displaced, left femur
• 3: Displaced, unspecified femur
• 4: Nondisplaced, right femur
• 5: Nondisplaced, left femur
• 6: Nondisplaced, unspecified femur

Per the ICD-10-CM Official Guidelines for Coding and Reporting, a fracture not indicated as displaced or nondisplaced should be coded as displaced. Unspecified laterality codes should be rare in orthopaedic documentation and are a common trigger for payer edits.

Femoral Neck and Head Fractures (S72.0-)

Femoral neck fractures are intracapsular and are often treated with internal fixation or arthroplasty depending on displacement and patient factors. Key subcategories include:

• S72.00-: Fracture of unspecified part of neck of femur
• S72.01-: Unspecified intracapsular fracture of femur
• S72.02-: Fracture of epiphysis (separation) (upper) of femur
• S72.03-: Midcervical fracture of femur
• S72.04-: Fracture of base of neck of femur (basicervical)
• S72.05-: Unspecified fracture of head of femur
• S72.06-: Articular fracture of head of femur
• S72.09-: Other fracture of head and neck of femur

Example: A displaced midcervical fracture of the right femur at the initial encounter is S72.031A.

Coding tip: Avoid S72.00- and S72.01- when imaging or the operative note specifies the fracture site. A surgeon who documents "subcapital" or "transcervical" or "basicervical" has given the coder what is needed to reach a specific code, but the coder may need to query when terminology is ambiguous.

Pertrochanteric Fractures (S72.1-)

Pertrochanteric fractures are extracapsular and most often treated with a cephalomedullary nail or a sliding hip screw. Subcategories include:

• S72.10-: Unspecified trochanteric fracture of femur
• S72.11-: Fracture of greater trochanter of femur
• S72.12-: Fracture of lesser trochanter of femur
• S72.13-: Apophyseal fracture of femur
• S72.14-: Intertrochanteric fracture of femur

Example: A displaced intertrochanteric fracture of the left femur at the initial encounter is S72.142A.

Subtrochanteric Fractures (S72.2-)

Subtrochanteric fractures use a placeholder X in the fifth position because the subcategory has no further site breakdown:

• S72.21X-: Displaced subtrochanteric fracture of right femur
• S72.22X-: Displaced subtrochanteric fracture of left femur
• S72.23X-: Displaced subtrochanteric fracture of unspecified femur
• S72.24X- through S72.26X-: Nondisplaced subtrochanteric fractures (right, left, unspecified)

Example: A displaced subtrochanteric fracture of the right femur at the initial encounter is S72.21XA. Dropping the X placeholder makes the code invalid, which is a surprisingly common rejection.

Seventh Characters: The Most Common Source of Errors

S72 codes use an expanded set of seventh characters that capture both encounter type and, for open fractures, the Gustilo classification:

• A: Initial encounter for closed fracture
• B: Initial encounter for open fracture type I or II
• 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

Initial vs. Subsequent Encounter

The ICD-10-CM guidelines define the initial encounter (A, B, C) as the period when the patient is receiving active treatment for the fracture, which includes surgical treatment, emergency department care, and evaluation and continuing treatment by the same or a different physician. The subsequent encounter (D through R) applies after active treatment is complete, when the patient is receiving routine care during the healing or recovery phase, such as cast changes, medication adjustment, and follow-up visits.

In practice, this means the surgery for a hip fracture is coded with A (for a closed fracture), and post-operative follow-up visits in the global period are coded with D for routine healing. A common error is carrying the A character forward to every follow-up visit.

Aftercare: Use the Fracture Code, Not Z Codes

The guidelines are specific: aftercare Z codes should not be used for aftercare of injuries such as fractures. Instead, report the acute fracture code with the appropriate seventh character for subsequent encounter. A post-operative visit after intertrochanteric fracture fixation is coded with S72.14-D, not Z47.89 or a Z09 follow-up code.

Delayed Healing, Nonunion, and Malunion

When the surgeon documents delayed healing, nonunion, or malunion, the seventh character must reflect it (G, K, or P for closed fractures). These distinctions matter for medical necessity on revision procedures and imaging, so documentation should explicitly state the healing status.

Sequela

The S character is used for complications or conditions that arise as a direct result of the fracture after it has healed, such as post-traumatic arthritis. Code the sequela condition first, followed by the fracture code with S.

Pathological, Osteoporotic, and Periprosthetic Hip Fractures

Not every hip fracture belongs in S72. Choosing the right category is critical for both accuracy and medical necessity.

• Osteoporotic fractures: When a fracture occurs in a patient with osteoporosis from minimal trauma that would not usually break normal bone, the guidelines direct coding to M80, osteoporosis with current pathological fracture. For example, M80.051A is age-related osteoporosis with current pathological fracture, right femur, initial encounter. Do not also assign an S72 code for the same fracture.
• Other pathological fractures: Fractures due to neoplastic disease are coded to M84.5- and those due to other diseases to M84.6-, with the underlying condition also coded. M84.45- covers pathological fracture of the femur and pelvis not elsewhere classified.
• Atypical femoral fractures: Associated with long-term bisphosphonate use, these are coded to M84.75-, with the appropriate drug-related code.
• Periprosthetic fractures: A fracture around an existing internal prosthetic hip joint is coded to M97.0-, such as M97.01XA for a periprosthetic fracture around an internal prosthetic right hip joint, initial encounter.

The documentation must clearly support which category applies. "Fragility fracture" or "low-energy fall in a patient with known osteoporosis" supports M80. "Ground-level fall" alone, without mention of osteoporosis, generally supports S72.

External Cause Codes

Although external cause codes are not universally required by payers, they add clinical context and are valuable for data quality. A typical hip fracture from a fall might include a fall code from W00 to W19 (for example, W19.XXXA for an unspecified fall), a place of occurrence code from Y92, and an activity code from Y93 when documented. External cause codes are reported only once, at the initial encounter, for the place of occurrence.

Pairing ICD-10 Codes With CPT for Hip Fracture Surgery

The diagnosis code must support the procedure. Common CPT codes for hip fracture surgery include:

• 27235: Percutaneous skeletal fixation of femoral fracture, proximal end, neck
• 27236: Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement (commonly used for hemiarthroplasty performed for femoral neck fracture)
• 27244: Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture with plate/screw type implant
• 27245: Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture with intramedullary implant

Two pairing checks catch most mismatches. First, a femoral neck procedure (27235 or 27236) should pair with an S72.0- code, while 27244 and 27245 should pair with S72.1- or S72.2-. Second, when total hip arthroplasty is performed for an acute fracture, confirm the correct CPT choice against current AMA CPT guidance and payer policy, because the coding approach for fracture-related arthroplasty differs from elective arthroplasty for osteoarthritis.

All four codes carry a 90-day global period, so follow-up visits are reported with 99024 and the fracture code with a subsequent-encounter seventh character.

Documentation Checklist for Hip Fracture Encounters

To support a complete, specific code, the surgeon's documentation should include:

• Fracture location using precise anatomic terms (subcapital, transcervical, basicervical, intertrochanteric, subtrochanteric)
• Laterality
• Displaced or nondisplaced status
• Open or closed, and the Gustilo type for open fractures
• Mechanism of injury and whether the fracture is traumatic, osteoporotic, pathological, or periprosthetic
• At follow-up, the healing status (routine, delayed, nonunion, malunion)
• Relevant comorbidities that affect risk, such as osteoporosis, anticoagulation, and dementia

Frequently Asked Questions

What is the ICD-10 code for a hip fracture?

There is no single code. Hip fractures are coded in category S72 based on location: S72.0- for femoral neck and head, S72.1- for pertrochanteric (including intertrochanteric, S72.14-), and S72.2- for subtrochanteric. Each code also requires laterality, displacement status, and a seventh character.

What is the ICD-10 code for a right intertrochanteric hip fracture?

A displaced intertrochanteric fracture of the right femur at the initial encounter is S72.141A. A nondisplaced intertrochanteric fracture of the right femur at the initial encounter is S72.144A.

Which seventh character should be used for post-operative hip fracture visits?

Once active treatment is complete, follow-up visits during routine healing use a subsequent encounter character, typically D for a closed fracture with routine healing. Use G, K, or P when delayed healing, nonunion, or malunion is documented.

Should aftercare Z codes be used after hip fracture surgery?

No. ICD-10-CM guidelines state that aftercare Z codes should not be used for injuries such as fractures. Report the fracture code with the appropriate subsequent encounter seventh character instead.

How do you code an osteoporotic hip fracture?

When a fracture results from minimal trauma in a patient with osteoporosis, code it to M80 rather than S72. For age-related osteoporosis with a current pathological fracture of the right femur at the initial encounter, use M80.051A.

How is a periprosthetic hip fracture coded?

A fracture around an existing internal prosthetic hip joint is coded to M97.0-, for example M97.01XA for the right hip at the initial encounter, rather than an S72 code.

The Bottom Line

Hip fracture coding rewards precision. The right subcategory, laterality, displacement, and seventh character turn a generic fracture code into one that supports the procedure, survives payer edits, and holds up in episode-based models like TEAM. Train coders on the seventh-character rules, build documentation prompts into your fracture templates, and audit the global period follow-up visits where most errors hide.

See how Maia's AutoCoder handles this automatically for orthopaedic practices. Book a demo at usemaia.com.