ICD code S72.101H – Unspecified trochanteric femur fracture with delayed healing

Key takeaways

S72.101H is a billable ICD-10-CM code for delayed healing at a follow-up after an open type I or II trochanteric fracture of the right femur

The 7th character H means a follow-up visit, an original open fracture of Gustilo type I or II, and documented delayed healing

Use G instead for a closed fracture with delayed healing, and J for an open type IIIA, IIIB or IIIC fracture

The 6th character 1 means the right femur, so use S72.102H for the left side and S72.109H only when the record names no side

During a 90-day global period, modifier 24 applies only to an E/M visit unrelated to the original surgery

ICD-10 code S72.101H: Full description and code details

ICD-10 code S72.101H carries the official descriptor: Unspecified trochanteric fracture of right femur, subsequent encounter for open fracture type I or II with delayed healing. It sits in category S72 (Fracture of femur) within Chapter 19 of ICD-10-CM, the injury chapter (S00-T88). The code is billable and valid for FY 2027, per the CMS ICD-10-CM annual code files.

What is an unspecified trochanteric fracture?

An unspecified trochanteric fracture is a break in the trochanteric region of the proximal femur where the record does not name the fracture subtype. The trochanteric region includes the greater trochanter, the lesser trochanter, and the intertrochanteric area between them.

In S72.101H, “unspecified” refers to the fracture subtype. The side is set by the 6th character, and here that character is 1, the right femur. The trochanteric codes split like this:

• S72.101-: Unspecified trochanteric fracture of right femur, the stem of this code
• S72.102-: Unspecified trochanteric fracture of left femur
• S72.109-: Unspecified trochanteric fracture of unspecified femur, for a record that names no side
• S72.11- through S72.14-: Greater trochanter, lesser trochanter, apophyseal and intertrochanteric fractures, used when the record names the subtype

Trochanteric fractures in older adults are often classified clinically as hip fractures. For coding purposes, the anatomical location determines the S72.1 subcategory. The lay term “hip fracture” can point to several different code categories.

Understanding the 7th character H: Open type I or II fracture with delayed healing

The 7th character in S72 codes carries three facts at once: The encounter type, whether the fracture was open or closed, and the healing status. For S72.101H, the H means a follow-up encounter for an open fracture of Gustilo type I or II, with delayed healing documented by the physician. It does not mean the fracture is untreated, and it does not mean nonunion.

The open fracture types come from the Gustilo-Anderson classification. Type I is an open fracture with a clean wound under 1 cm, and type II has a larger wound without extensive soft-tissue damage. Types IIIA, IIIB and IIIC involve extensive soft-tissue injury, periosteal stripping, or an arterial injury that needs repair. An open fracture with no documented type is coded as type I or II.

The full S72 7th-character set, from the ICD-10-CM Tabular List, is below. The three delayed healing characters (G, H and J) are where coders slip most often:

The original wound decides between H, G and J. A closed trochanteric fracture of the right femur with delayed healing is S72.101G. An open type IIIA, IIIB or IIIC fracture with delayed healing is S72.101J. Only an open type I or II fracture, or an open fracture with no documented type, lands on S72.101H. The three questions below walk a follow-up note to the right character.

Delayed healing means the fracture is still healing, but more slowly than expected. Nonunion (M for an open type I or II fracture) means it has failed to heal. A radiologist’s note of “no bridging callus at 12 weeks” can support delayed healing. Even so, the physician’s assessment must state the diagnosis before H can be coded.

How S72.101H differs from related fracture codes

S72.101H sits among dozens of close siblings in the S72.1 subcategory. Picking the wrong one is a common cause of rejected orthopedic and emergency department claims. The table below covers the codes coders most often confuse:

The S72.101H versus S72.101M split matters most for payer review. Delayed healing usually means continued monitoring, while a documented nonunion can open a separate authorization pathway for revision surgery. Verify the physician’s exact language before choosing between them.

Documentation requirements for S72.101H

ICD-10-CM Official Guidelines require coders to assign codes based only on diagnoses the treating provider documents. For S72.101H, five documentation elements must be present before the code can be assigned. Claims management software that flags an incomplete record before submission lets an orthopedic practice fix the note before the claim goes out.

• Encounter type: The note must show a follow-up visit, not a visit where active treatment is still underway. Language such as “returns for follow-up,” “seen in clinic for fracture check,” or “post-operative visit” meets this requirement.
• Open fracture and Gustilo type: The record must document that the original fracture was open, along with the date of injury. Type I or II, or an open fracture with no type stated, supports the H character. A documented type IIIA, IIIB or IIIC moves the code to J.
• Explicit delayed healing diagnosis: The physician must use “delayed healing,” “delayed union,” or equivalent clinical language. A radiologist noting “incomplete callus formation” does not support H on its own. The treating clinician must adopt that finding as a diagnosis in the assessment.
• Imaging support: The record should hold radiographic findings showing no bridging callus where it’s expected. For trochanteric femur fractures, that is typically eight to twelve weeks after the injury.
• Laterality: The record must name the right femur. A left-sided fracture takes S72.102H, and S72.109H is reserved for a record that names no side.

Coders who infer delayed healing from imaging reports without a matching physician diagnosis are assigning a code not supported by the documentation. That practice fails payer audits and constitutes an overstated claim under federal billing rules.

Which CPT codes are commonly paired with S72.101H?

At a follow-up for delayed healing, the procedure codes billed alongside S72.101H depend on what the provider did at that visit. The trochanteric fracture repair codes 27244 and 27245 are billed at the operative encounter and are not billed again at follow-ups. The table below lists the pairings an orthopedic practice sees most often across those follow-up visits.

Pabau, the practice management and billing platform we build, sends these claims electronically through Claim.MD, its US clearinghouse integration. Claim.MD checks modifier and code combinations before the claim leaves the practice. Claim.MD connects to thousands of US payers. That real-time edit catches mismatched modifiers and unbundling flags before they reach the payer and generate a denial.

Payer requirements and prior authorization

Medicare and most commercial payers treat delayed healing fracture management as a coverage-sensitive service. Local Coverage Determinations (LCDs) from Medicare Administrative Contractors (MACs) set which interventions are covered at follow-up encounters. They also set the documentation payers need before approving them.

Key payer requirements to confirm before submitting a clean claim with S72.101H:

• Bone stimulator authorization: Medicare’s osteogenesis stimulator LCD covers non-spinal stimulators for fracture nonunion, not for delayed union. A stimulator request on S72.101H alone is therefore likely to fail with Medicare. Commercial policies vary, so check the payer’s own criteria before submitting.
• Global period modifier compliance: CMS assigns a 90-day global surgical period to the trochanteric fracture repair codes 27244 and 27245. Under Medicare, follow-up care for complications that don’t need a return to the operating room is part of that package. Modifier 24 applies only to an unrelated E/M, and modifier 57 to a visit where the decision for surgery is made.
• Delayed healing versus nonunion distinction: Payers audit claims where H and M are applied inconsistently across the same episode of care. A patient moves from H to M only when the physician’s assessment moves from “not healing as expected” to “has failed to heal.” Switching back and forth raises audit flags.
• ICD-10-CM code pair on authorization requests: Requests for surgery at a follow-up encounter should list S72.101H as the current diagnosis. Where the payer requires one, add an external cause code describing how the original open fracture happened.

Common claim denial reasons for S72.101H and how to avoid them

Claim denials tied to ICD-10 code S72.101H cluster around a predictable set of documentation and sequencing errors. Each one comes back on the remittance with a denial code that points to its cause. Practices with structured denial management workflows fix these patterns at the source rather than one claim at a time.

• H applied without documented delayed healing: The most common denial. Imaging shows incomplete healing, but the physician’s assessment says “healing progressing” or “continue current management.” Corrective action: Query the physician to amend the note, or recode to S72.101E (routine healing) if H is not supported.
• H used during active treatment: The open fracture is still in active treatment, but the visit carries the H character. Active treatment of an open type I or II fracture takes B, however long ago the injury occurred. Corrective action: Recode to S72.101B and resubmit.
• H used for a closed or type III fracture: The record documents a closed fracture or a Gustilo type III wound, but H was submitted. Corrective action: Recode to S72.101G for a closed fracture or S72.101J for type III, then resubmit.
• Laterality mismatch: The operative report or imaging documents the left femur, but S72.101H (right femur) was submitted. Payers cross-reference laterality between diagnosis and procedure codes. Corrective action: Assign S72.102H for the left side and resubmit, keeping S72.109H for a record that names no side.
• Missing modifier 24 on an unrelated visit: An E/M for an unrelated problem was billed in the 90-day global period without modifier 24. Corrective action: Add modifier 24, document why the visit is unrelated, and resubmit. A visit that only follows up the delayed healing stays bundled under Medicare.
• H applied when M is correct: The physician has documented nonunion, but the coder submitted S72.101H (delayed healing) instead of S72.101M. Payers deny requests for revision surgery when the submitted code says delayed healing. Corrective action: Review the physician’s exact language in the assessment and recode accordingly.
• Unbundling within global period: Fracture care CPT codes re-billed at a follow-up in the 90-day global period are denied as bundled. Payers treat them as part of the original surgical payment. Corrective action: Bill only a separately payable service, and rebill the fracture care code only when a new, distinct episode of care has begun.

ICD-10 coding guidelines: S72 category rules

The CDC/NCHS ICD-10-CM Official Guidelines for Chapter 19 establish specific rules governing how S72 fracture codes are assigned. These rules apply to S72.101H and its entire sibling code family:

• Open versus closed: A fracture not documented as open or closed is coded as closed. S72.101H is an open fracture code, so the record must state that the fracture was open. The open fracture characters are B and C, E and F, H and J, M and N, and Q and R.
• Gustilo type default: Open fracture designations follow the Gustilo classification. An open fracture with no documented type is coded as type I or II, which keeps a delayed healing follow-up on H.
• 7th character assignment: Every S72 code must carry a 7th character. When the code has fewer than six characters, placeholder X fills the empty positions. S72.101H already has six characters (S72.101) before H, so no placeholder is needed.
• External cause codes: Codes from the V, W, X and Y series describe how the injury happened. ICD-10-CM has no national mandate to report them, so follow your payer’s or state’s rules. Where one is reported, it is never sequenced ahead of S72.101H.
• Active treatment definition: The initial encounter characters (A, B and C) apply to every visit where the fracture receives active treatment. A new surgeon who takes over active treatment six weeks after the injury still reports B for an open type I or II fracture. This rule is a frequent source of confusion with H and E.

Understanding these rules is part of broader medical billing compliance requirements for orthopedic practices. Misapplying the open or closed rule, or the active treatment definition, is a common source of encounter coding errors. The ResDAC coding resources page provides additional guidance on how these rules apply within Medicare claims data.

How Pabau supports orthopedic billing workflows

Orthopedic and musculoskeletal practices managing hip fracture patients across multiple follow-up visits need billing workflows that catch 7th-character errors before they reach the payer. Pabau covers the full medical billing workflow, from diagnosis code selection through claim submission via Claim.MD.

Pabau helps orthopedic teams structure clinical notes around the elements S72.101H requires: Encounter type, open fracture and Gustilo type, delayed healing language, imaging, and laterality. When the care team captures those fields at the point of care, coders can assign the correct 7th character with confidence. They no longer need to query the provider after the fact.

Book a demo to see how Pabau handles orthopedic billing documentation end to end.

Reduce ICD-10 claim denials from the source

Pabau helps orthopedic and musculoskeletal practices capture the documentation behind the correct 7th character at every follow-up. That cuts denials on complex fracture codes before the claim goes out.

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Conclusion

Assign S72.101H only when the treating physician’s assessment names delayed healing in an open type I or II fracture of the right femur. Imaging can prompt a query to the physician, but it cannot replace that diagnosis on the claim.

The fix that pays off sits upstream of coding. A follow-up note template that records the Gustilo type, the side and the healing status lets coders pick G, H or J without querying anyone. Pabau’s electronic remittance advice tools then surface the remaining denials by code, so your team fixes the workflow instead of chasing single claims.

Book a demo to see how Pabau keeps your fracture follow-up claims on the right 7th character.

Continue your research

Need to understand how claim denials are tracked and resolved? Denial management in healthcare covers the end-to-end workflow for identifying, appealing, and preventing common payer rejections.

Preparing a clean claim for a fracture follow-up visit? Submitting a clean claim walks through the specific data elements payers check before processing a payment.

Want to understand the clearinghouse that validates your S72 claims? Claim.MD clearinghouse overview explains how electronic claim validation works before submission to thousands of US payers.

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