ICD-10 code S72.345C: Nondisplaced spiral fracture, left femoral shaft

Key takeaways

ICD-10 code S72.345C is a nondisplaced spiral fracture of the shaft of the left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC.

The 7th character C is reserved for Gustilo type III open wounds. The same fracture with a type I or II wound is S72.345B.

The 6th character 5 carries both nondisplaced status and left laterality within the S72.34- spiral shaft subcategory.

S72.345C is a shaft fracture. Condyle injuries sit in S72.43- and take different CPT procedures.

Practice management software like Pabau prompts for the five documentation elements this code needs and flags code conflicts before submission.

ICD-10 code S72.345C is a billable diagnosis code for a nondisplaced spiral fracture of the shaft of the left femur. The 7th character C narrows it to an initial encounter for an open fracture of Gustilo type IIIA, IIIB, or IIIC.

One transposed character separates it from a very different injury. S72.435C sits in the medial condyle family at the knee. Move the 4th and 5th characters and the fracture shifts from mid-thigh to knee level, taking the correct CPT pairings with it.

The sections below break the code down character by character and map the Gustilo-Anderson grades behind the C character. They also cover the sibling codes it gets confused with, the CPT pairings, companion codes, and the five documentation elements the code depends on.

ICD-10 code S72.345C: Definition and billable status

S72.345C is a billable diagnosis code in the ICD-10-CM classification system. Its full official descriptor is: Nondisplaced spiral fracture of shaft of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC. The FY2026 version of the code took effect on October 1, 2025.

According to the CMS ICD-10-CM resources, S72.345C is valid in both inpatient and outpatient settings while the fracture is under active treatment.

It belongs on a claim only when the physician’s documentation confirms five separate elements. Those are the shaft location, the spiral fracture pattern, nondisplaced status, a left-sided injury, and a Gustilo type III open wound.

Breaking down the code, character by character

Each character position in S72.345C carries a separate piece of clinical meaning. Misread any one of them and you have coded a different injury. Here is what each position encodes.

The 6th character does double duty in this subcategory. Within S72.34-, digits 1, 2, and 3 mark displaced fractures on the right, left, and unspecified side.

Digits 4, 5, and 6 mark nondisplaced fractures in the same order. So the 5 in S72.345C encodes nondisplaced status and left laterality together.

What the 7th character C means

In S72.345C, the 7th character C means one thing: an initial encounter for an open fracture graded Gustilo type IIIA, IIIB, or IIIC. It is not a generic marker for the first visit, and it does not cover type I or II wounds. The same fracture with a type I or II open wound is S72.345B.

Two errors dominate this position. The first is treating C as shorthand for any open fracture when it is reserved for the type III grades. The second is holding C through the whole healing episode. Once active treatment ends, an open type III fracture moves to F, J, N, or R, depending on how it heals.

Gustilo-Anderson classification and 7th character selection

The Gustilo-Anderson system grades open fractures by wound size, contamination, and the extent of soft tissue and neurovascular injury. ICD-10-CM uses that grading to decide between 7th characters B and C, following Section I.C.19 of the Official Guidelines for Coding and Reporting.

Coders cannot assign a Gustilo grade themselves. The treating physician has to document it. If the operative or emergency report does not state the grade, query the provider before the claim goes out. Upgrading an unspecified open wound to type III so that S72.345C fits will not survive an audit.

Clinical context: Nondisplaced spiral femoral shaft fracture

The femoral shaft is the long diaphyseal segment between the subtrochanteric region and the distal metaphysis. A spiral pattern means the fracture line winds around the bone, which points to a twisting force rather than a direct blow. Nondisplaced means the fragments have not shifted out of anatomical alignment.

The combination captured by S72.345C is clinically unusual, and that is worth flagging at the coding stage. A Gustilo type III wound signals high-energy trauma with extensive soft-tissue loss, periosteal stripping, or arterial injury. The bone itself, though, has not displaced.

Management follows the soft-tissue grade rather than the fracture alignment. In practice that means urgent irrigation and debridement, IV antibiotics, and often external fixation before definitive nailing.

Spiral femoral shaft fractures also carry a documentation dimension outside orthopedics. In a child who is not yet walking independently, this pattern prompts an evaluation for non-accidental injury, which brings its own codes and reporting duties. In adults it usually accompanies external cause codes from the V-series for transport accidents or the W-series for falls. Australian practices bill the equivalent service through MBS item numbers, which carry their own descriptors and eligibility rules. Where a payer still requires a paper claim, the practice needs the current revision of the form.

Orthopedic and physical therapy EMR workflows need this level of specificity from the first encounter. According to the CDC ICD-10-CM tool, the initial encounter character covers every visit during active treatment. It is not limited to the first appointment.

ICD-10 coding guidelines for S72.345C

Section I.C.19 of the ICD-10-CM Official Guidelines for Coding and Reporting governs traumatic fracture coding. These rules decide when S72.345C is correct and when it has to change.

Practice management software like Pabau runs claims management checks that flag code conflicts before submission. Coders still need to know the underlying rules.

• Use the initial encounter character for every active treatment visit: Any visit involving active fracture treatment uses C for this code. That includes surgery, debridement, external fixation, and antibiotic infusion, not just the first appointment.
• Move to a subsequent encounter character when active treatment ends: Follow-up care on an open type III fracture uses F for routine healing. Delayed healing takes J. Nonunion takes N, as in N, as in S72.309N, and malunion takes R.
• Reserve the sequela character (S) for late effects: Use S only when a condition arises from the healed fracture, such as a leg length discrepancy. The fracture itself is no longer the reason for the visit.
• Do not code the open wound separately: The open fracture 7th character already accounts for the wound. An open wound code from S71.10- is not reported alongside S72.345C for the same site.
• Report an external cause code: ICD-10-CM guidelines expect a code identifying the mechanism. That is a V-series code for a transport accident, or a W-series code for a fall.
• Sequence the fracture first: S72.345C is the principal diagnosis when the fracture is the reason for the encounter. Complications and comorbidities follow as additional diagnoses.

When to use S72.345C vs related codes

The S72.34- subcategory covers spiral fractures of the femoral shaft on both sides and in both displacement states. Picking the wrong sibling is the most common specificity error in this family. The table below lists all six base codes with the 7th character C applied.

Side and displacement are the only variables in that table. Every row describes the same spiral shaft pattern at the same open type III initial encounter. Use S72.344C for the right femur, and S72.342C when the same left-sided fracture is displaced.

S72.346C exists for genuinely undocumented laterality. Many payers deny it when the rest of the claim names the side, which makes it a recurring item in denial management. Verify the full 7th-character list for any sibling in the AAPC ICD-10-CM lookup.

Adjacent subcategories change the fracture pattern rather than the side. A nondisplaced transverse fracture of the left shaft is S72.325C, and the oblique equivalent is S72.335C. Comminuted and segmental patterns sit in S72.35- and S72.36-.

Drop below the shaft and the family changes again, to codes such as S72.442C for the lower end of the femur. At the vague end of the family, S72.91XH applies when the note gives neither the site nor the fracture pattern.

Common coding errors to avoid

The errors below account for most audit findings on this code, and for most of its denial codes. Each one comes from reading a single character position too quickly.

• Confusing the shaft family with the condyle family: S72.435C describes a nondisplaced fracture of the medial condyle of the left femur. That is a knee-level injury in the S72.4- lower end group, not a variant of S72.345C.
• Reading C as any open fracture: C covers Gustilo type IIIA, IIIB, and IIIC only. Type I and II wounds take B, and closed fractures take A.
• Keeping C after active treatment ends: The character has to change once the patient moves into follow-up care. Otherwise the claim describes the wrong phase of the episode.
• Coding a pathological fracture in the S72 series: Osteoporotic and neoplastic fractures belong in the M80 or M84 series, not S72.
• Assuming displacement from imaging: The physician has to state nondisplaced. A coder cannot infer it from a radiology image alone.
• Defaulting to unspecified laterality: S72.346C should be rare, because the side of a femur fracture is almost always documented somewhere in the record.

CPT codes commonly paired with S72.345C

Procedure selection follows what was performed, and for a femoral shaft fracture that means shaft procedures. Distal femur and condyle codes such as 27514 do not belong on a claim carrying S72.345C.

The codes below are common pairings rather than automatic ones, and each has to match the operative report. Practices handling this volume often validate diagnosis and procedure pairs inside sports medicine software.

Nondisplaced status makes closed treatment plausible for the bone in S72.345C. A type III wound rarely allows it in practice, so 27506 alongside a debridement code is the more typical pairing. Temporary external fixation under 20690 often comes first.

Debridement codes need documented wound size, tissue depth, and foreign material removed. Our references on 11011 and 11012 cover the depth distinction that separates them.

For reimbursement rates, the CMS fee schedule tool gives current RVU-based amounts by CPT code and geographic locality.

Documentation requirements for accurate coding

S72.345C needs five documented elements, and each one maps to a character position in the code. Miss any of them and the coder has to fall back to a less specific code, which affects both reimbursement and audit exposure. Structured medical forms and clinical records workflows capture all five at the point of care.

1. Fracture site: The note has to say shaft, midshaft, or diaphysis of the femur. Distal femur or thigh alone will not support this code, and the radiology report is the strongest supporting document.
2. Fracture pattern: Spiral must be stated. Transverse, oblique, comminuted, and segmental patterns all route to different subcategories of S72.3.
3. Displacement status: The physician must state displaced or nondisplaced, because this drives the 6th character alongside laterality.
4. Open wound and Gustilo grade: The phrase open fracture alone will not support the C character. The operative or emergency report needs the grade, which is the element most often missing.
5. Laterality: Left or right has to be explicit in the physician’s note. Do not take it from patient history or from surrounding context.

Build a query workflow for open fracture cases where the Gustilo grade is absent from the first note. Querying the provider before submission always costs less than reworking a denied claim.

Practices that hold themselves to medical billing compliance standards usually catch a missing grade at intake.

Companion codes on the same claim

S72.345C rarely appears alone on a claim. A high-energy open fracture brings companion diagnoses, and payers often expect codes that establish the mechanism and support medical necessity.

The last row marks a code family boundary rather than a companion diagnosis. If osteoporosis or metastatic disease caused the fracture, S72.345C is wrong and the M80 or M84 series applies. When a patient with osteoporosis also has a documented fall, the physician has to say whether the fracture is traumatic or pathological.

How Pabau supports accurate femur fracture coding

Fracture coding fails at the documentation stage far more often than at the code lookup stage. The five elements S72.345C depends on are clinical facts that someone has to record in the right field, on the day of the encounter.

Pabau keeps that capture structured. Clinical forms prompt for site, pattern, displacement, laterality, and Gustilo grade, so a coder is not reconstructing them from free text a week later.

Claims tools then check the diagnosis and procedure pairing before submission, so a shaft diagnosis does not go out with a condyle procedure attached. Our Claim.MD integration submits the validated claim electronically from there.

For an orthopedic or musculoskeletal practice, the outcome is fewer provider queries after the fact and fewer reworked claims. Coders get complete notes, and billing gets a higher clean claim rate on first submission.

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Pabau helps orthopedic and physical therapy practices manage clinical documentation, code validation, and claims in one place, so accurate ICD-10 coding turns into faster reimbursement.

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Conclusion

Getting S72.345C right comes down to two character positions. Read the 4th and 5th to confirm you are in the spiral shaft family and not the condyle group in S72.4-. Read the 7th to confirm the physician graded the wound as Gustilo type III.

The trade-off worth remembering is timing. Querying the physician for a missing grade delays the claim by a day or two. Submitting without it risks a denial and a rework that costs far more, and it drags every follow-up claim in the episode with it.

For practices handling trauma coding volume, Pabau’s practice management software supports the structured documentation this specificity depends on. To see how it handles orthopedic documentation and billing workflows, book a demo with our team.

Continue your research

Coding a femoral neck fracture instead? S72.036E covers the nondisplaced midcervical pattern and the documentation each character depends on.

Reporting a late effect long after the injury? S72.124S shows how the sequela character works on a femur fracture.

Grading an open fracture as type I or II? S82.191B shows the B character at work on the tibial side of the same injury.

Coding a fracture that healed out of alignment? S82.499Q walks through the malunion character on a fibular shaft fracture.

Coding a sphenoid sinus procedure? CPT code 31051 guide covers billing for an open sphenoid sinusotomy with mucosal stripping or polyp removal.

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