ICD code S72.344F – Nondisplaced spiral fracture of the right femur shaft

Key takeaways

S72.344F codes a nondisplaced spiral fracture of the right femur shaft at a subsequent encounter. The wound must be an open Gustilo type IIIA, IIIB, or IIIC injury that is healing routinely.

Seventh character F covers open type IIIA, IIIB, or IIIC fractures only. Delayed healing takes J, the initial encounter takes C, and a closed fracture takes D.

Per ICD-10-CM Official Guidelines, fractures are presumed displaced unless the record explicitly states nondisplaced, so documentation must confirm displacement status.

Pabau’s claims management software flags seventh-character mismatches before submission, reducing denial rates on fracture aftercare claims.

ICD-10 code S72.344F: Full description and code breakdown

ICD-10 code S72.344F is a valid, billable ICD-10-CM diagnostic code for FY2026, confirmed in the current CMS tabular list.

Coders should verify annually against the CMS ICD-10 codes page since code validity is updated each October 1.

The official descriptor reads: Nondisplaced spiral fracture of shaft of right femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing. Every character in the code encodes a specific clinical decision.

The sixth character distinguishes displacement and laterality simultaneously: 4 = nondisplaced, right side. The seventh character F separates this open-fracture aftercare code from the matching initial encounter, S72.344C. It also separates it from the problem-encounter variants for the same wound grade: J, N, and R.

What S72.344F covers: Inclusion criteria and clinical scope

S72.344F applies when all six of the following conditions are documented in the clinical record for the encounter being billed.

• Open fracture, Gustilo type IIIA, IIIB, or IIIC: the fracture communicates with an external wound, and the record grades the soft-tissue injury at that level
• Shaft location: the fracture is in the diaphysis (mid-segment) of the femur, not the neck, head, trochanteric region, or condyles
• Spiral morphology: the fracture line follows a helical path around the bone, typically caused by a rotational or torsional force
• Nondisplaced: fracture fragments remain in anatomical alignment; the physician’s note must state “nondisplaced” explicitly
• Right side: the fractured femur is the patient’s right femur; left femur requires S72.345F
• Subsequent encounter with routine healing: the patient is presenting for follow-up care after initial management, and the healing trajectory is uncomplicated

A spiral fracture of the femoral shaft is most commonly caused by indirect rotational forces. Falls involving a planted foot and sporting injuries are typical presentations. A type III open wound points to high-energy trauma, such as a motor vehicle collision. The nondisplaced variant means the bone held position after the fracture, which influences treatment planning and the documentation a coder needs to see.

Exclusions: What this code does not cover

Using S72.344F for any of the scenarios below creates an immediate coding error and a likely denial. The code is narrowly defined and has no flexibility across these exclusion boundaries.

• Displaced fracture: use S72.341F (displaced spiral, right femur, subsequent encounter for open type IIIA, IIIB, or IIIC with routine healing)
• Left femur: use S72.345F; unspecified laterality defaults to S72.346F
• Closed fracture: F is reserved for open wounds graded type IIIA, IIIB, or IIIC; a closed spiral fracture healing routinely takes S72.344D instead
• Open fracture type I or II: a Gustilo type I or II wound healing routinely at a follow-up visit takes S72.344E, not F
• Initial encounter (active treatment): use S72.344C for the visit where management of this open type III fracture begins
• Delayed healing: use S72.344J when follow-up imaging shows an open type III fracture healing slower than expected
• Nonunion: use S72.344N; malunion uses S72.344R for the same wound grade
• Periprosthetic fracture: fractures around a prosthetic implant require codes from the M97 category, not S72
• Femoral neck or trochanteric fractures: coded under S72.0x and S72.1x respectively, not S72.3x

Decoding the seventh character: S72.344C vs S72.344D vs S72.344F vs S72.344J

The seventh character is where most billing errors on this code originate. Each character maps to a specific clinical scenario, and selecting the wrong one is functionally equivalent to billing for the wrong encounter type. Two documented facts settle the choice every time: the grade of the wound and the healing status at this visit. The grid below plots the full S72.344x family against both.

The table below carries the official descriptor wording behind each of those letters. ICD-10-CM never uses I, L, or O in this position, because they read too easily as the digits 1 and 0. Section I.C.19 of the ICD-10-CM Official Guidelines governs the whole set.

The critical distinction between F and J: Both cover an open type IIIA, IIIB, or IIIC fracture at a follow-up visit. Use F where the note documents healing as expected, with callus formation visible, pain decreasing, and weight-bearing improving. Use J where the note documents slow healing, absent callus at the expected timeframe, or clinical concern about the trajectory. Billing F when J is clinically correct misrepresents the encounter and triggers a denial.

The distinction between D and F: Both describe a subsequent encounter with routine healing, and the wound decides which one applies. D applies to a closed fracture, and F applies to an open wound graded Gustilo type IIIA, IIIB, or IIIC. A type I or II wound takes E instead of either one. The Gustilo grade in the operative or emergency record settles it, so there is no coder discretion here.

S72.344F vs sibling codes: Navigating the S72.34x family

The S72.34x group covers all spiral fractures of the femoral shaft. Within it, displacement status and laterality are the only differentiators. The table below maps the full sibling set for subsequent encounters carrying seventh character F, meaning routine healing. Use it to select accurately when laterality or displacement is in question. Pabau’s diagnostic codes library carries the complete tabular listing for each one.

Spiral vs oblique fracture morphology: A spiral fracture has a helical fracture line wrapping around the bone shaft. An oblique fracture runs diagonally across the shaft without rotating around it. Oblique femur shaft fractures are coded under the S72.33x group. Confusing the two morphologies means billing a code that does not match the imaging report, which payers catch on medical review.

CPT codes commonly paired with S72.344F

S72.344F is a diagnosis code, not a procedure code. Every claim using it needs at least one CPT code describing what was done at that encounter. The codes below are commonly used alongside S72.344F in orthopedic and physical therapy settings. CPT-to-ICD pairings are not universally mandated. Individual payer local coverage determinations (LCDs) may impose specific pairing requirements, so verify with the billing payer before you assume a pairing is accepted.

Physical therapy providers handling femur fracture aftercare should confirm which of these procedures their state allows PT staff to bill. Scope-of-practice rules vary by state. A modality billed outside them is denied regardless of how carefully the diagnosis was coded.

Documentation requirements for payers

Payers adjudicating S72.344F claims audit the medical record for several specific elements. A claim that passes edit checks at submission can still be reversed on post-payment audit if the documentation does not support the code. The list below reflects what standard payer LCDs expect to see in the record.

• Encounter type confirmed as follow-up: the note must establish this is not the first treatment encounter for this fracture episode
• Right-side laterality documented: the clinical note, imaging report, or operative report must specify the right femur
• Fracture type stated: spiral morphology should appear in the imaging report or clinical description; “spiral” is not interchangeable with “oblique” or “comminuted”
• Gustilo grade documented: the operative or emergency record must grade the open wound as type IIIA, IIIB, or IIIC. A type I or II wound takes seventh character E instead of F
• Nondisplaced status explicit: the physician must state “nondisplaced” in their assessment; absence of this qualifier requires defaulting to displaced per ICD-10-CM guidelines
• Healing status documented: the note must indicate that healing is progressing routinely, with imaging evidence or clinical assessment supporting this conclusion
• Absence of complications: no documentation of infection, hardware failure, delayed union, or vascular compromise at this encounter
• External cause code: include the appropriate V00-Y99 external cause code identifying the mechanism of injury; this is required per ICD-10-CM Official Guidelines for traumatic fractures

Common claim denial reasons for S72.344F and how to avoid them

Femur fracture subsequent-encounter codes generate a specific cluster of denials that differ from initial-encounter fracture claims. The patterns below reflect the most common reasons commercial payers and Medicare reject S72.344F claims. The grouping follows how denial management workflows classify these rejections.

• Wrong seventh character (most common): billing S72.344F when the note documents delayed healing, where J is correct, or during active treatment, where C is correct. Reconcile the seventh character against the documented healing status before submission
• Open and closed mixed up: seventh character F is valid only for a Gustilo type IIIA, IIIB, or IIIC wound. A closed fracture at the same stage takes D, and a type I or II open wound takes E
• Laterality mismatch: the claim shows the right femur, but the imaging report, operative notes, or prior claim history reference the left femur. Radiology reports and claim history must match
• Displaced fracture coded as nondisplaced: the original imaging described a displaced fracture, and the record shows no reduction to anatomical alignment. In that case S72.341F is correct, not S72.344F
• Missing healing status documentation: the physician note describes the encounter without stating that healing is “routine,” “on track,” or “progressing normally.” Payers require explicit healing-status language, not inference
• Periprosthetic fracture miscoded: a fracture occurring around a hip prosthesis requires M97.x codes. Billing S72.344F for one is a coding error that triggers denial and a potential audit
• No external cause code: traumatic fracture claims need a mechanism-of-injury code from the V00-Y99 range. Payer LCDs that require external cause coding will reject claims without one
• Payer LCD restriction: some Medicare Administrative Contractors restrict specific services, such as physical therapy modalities, when they are paired with fracture aftercare codes. Verify the applicable LCDs before billing

Running a pre-submission review on every S72.344F claim catches most of these while the record is still open. The seventh-character check alone resolves the majority of the patterns above. Practices using claims management software can run that review automatically on each claim.

Official ICD-10-CM guidelines governing this code

The CDC/NCHS ICD-10-CM web tool publishes the official tabular list used to verify S72.344F and its sibling codes. The governing coding rules for this code fall primarily under Section I.C.19 of the ICD-10-CM Official Guidelines for Coding and Reporting. Key rules that directly affect S72.344F use are outlined below.

Displacement presumption rule

Per Section I.C.19.c of the Official Guidelines, fractures are presumed displaced unless the provider’s documentation explicitly states nondisplaced. This means S72.344F requires the word “nondisplaced” in the clinical record. No exception exists for radiologic inference; the coder cannot look at an X-ray description and decide displacement status independently.

External cause code requirement

Traumatic fractures coded under Chapter 19 require sequencing with an external cause code from Chapter 20 (V00-Y99). The external cause code identifies the mechanism of injury (e.g., a fall, a motor vehicle collision, a sports injury). The fracture code S72.344F is sequenced as the principal or first-listed diagnosis; the external cause code follows. This sequencing rule applies at every encounter in the episode, not only the initial one.

Multiple injury sequencing

When the patient presents with multiple injuries from the same incident, the most severe injury is sequenced first. If the femur fracture is the primary diagnosis driving the encounter, S72.344F takes precedence. Additional injury codes for the same episode follow in descending clinical significance. The AAPC ICD-10-CM code reference lists the adjacent injury codes that often apply to multitrauma encounters involving a femoral shaft fracture.

How Pabau supports fracture aftercare coding and documentation

The documentation a payer wants on an S72.344F claim already exists somewhere in the record. The Gustilo grade sits in the operative report, the displacement wording in the physician’s assessment, and the healing status in the most recent follow-up note. Locating all three before the claim goes out is the coder’s job.

Practice management software like Pabau keeps those three in one patient file. Treatment notes, digital forms, and uploaded imaging reports attach to the same record as the appointment. A coder reviewing a subsequent encounter reads the episode in sequence instead of chasing the operative report through another system.

Pabau’s claims management tools then check the diagnosis and procedure pairing before submission. A seventh character that contradicts the documented healing status is flagged on screen. That is weeks earlier than a remittance advice would raise it, and it is the difference between a correction and a rework.

Reduce femur fracture claim denials before they happen

Pabau’s claims management software validates ICD-10 and CPT code combinations before submission and flags seventh-character mismatches. It streamlines fracture aftercare billing so your team spends less time on rework and more time on patient care.

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Conclusion

Assigning S72.344F correctly depends on the operative report as much as the diagnosis line. The wound grade and the healing language decide the seventh character, and both sit outside the fields a coder usually works from. Pulling those two facts before you assign the code is the habit worth building.

The trade-off worth remembering is that the presumption runs against you. A note reading only “spiral fracture” codes as displaced, whatever the imaging suggests. Querying the physician costs an afternoon. An audit reversal months later costs the payment and the staff time to rebuild the claim.

Moving that check upstream turns a denial into a question you answer before submission. Book a demo to see how Pabau catches seventh-character and pairing errors on fracture aftercare claims before they reach the clearinghouse.

Continue your research

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