ICD code S72.365C – Nondisplaced segmental fracture of the shaft of the left femur

Key takeaways

S72.365C is a billable ICD-10-CM code for a nondisplaced segmental fracture of the shaft of the left femur. It covers the initial encounter for an open fracture of type IIIA, IIIB, or IIIC.

A segmental fracture has two separate fracture lines that isolate a free segment of the femoral shaft. It is not a joint-surface fracture.

The 7th character C covers only Gustilo types IIIA, IIIB, and IIIC. Open type I or II, or an open fracture with no Gustilo type documented, takes B (S72.365B).

The note must state left side, nondisplaced, segmental pattern, open wound, and a type III Gustilo grade. Without a displacement statement, guidelines default to displaced (S72.362C).

Pabau, the practice software we build, keeps the fracture note and the insurance claim in one record. The coder bills from the surgeon’s own entries.

ICD-10 code S72.365C: Quick reference

ICD-10 code S72.365C is the billable ICD-10-CM code for a nondisplaced segmental fracture of the shaft of the left femur. It applies at the initial encounter for an open fracture documented as Gustilo type IIIA, IIIB, or IIIC.

S72.365C has been a valid, billable ICD-10-CM code since ICD-10-CM took effect in the US on October 1, 2015. The table below gives coders the core facts before the clinical and billing detail. For current-year validity, check the CDC/NCHS ICD-10-CM web tool, which is updated each October 1.

What each character in S72.365C means

S72.365C encodes five clinical facts, each carried by a character position. S72 is the category (fracture of femur), and .3 narrows it to the shaft. The 6 in .36 specifies a segmental fracture of the shaft. The 5 in .365 adds displacement status (nondisplaced) and laterality (left). C sets the encounter as initial, for an open fracture of Gustilo type IIIA, IIIB, or IIIC.

A segmental fracture breaks the femoral shaft at two levels, leaving a separate segment of bone between the two fracture lines. It differs from a transverse, oblique, or spiral fracture, which has one fracture line. It also differs from a comminuted fracture, which shatters into multiple fragments at one site. Nondisplaced means the fragments have not shifted out of anatomical alignment. Both findings must appear in the physician’s documentation, not only in the imaging report. The same segmental pattern on the tibial shaft, displaced and at an open type III follow-up, takes S82.263F.

The 7th character C: Gustilo type III open fractures

The 7th character C designates an initial encounter for an open fracture of Gustilo-Anderson type IIIA, IIIB, or IIIC. It does not cover type I or II fractures, which take B in place of C for this code. An open fracture has a skin wound that communicates with the fracture site. That wound carries an infection risk closed fractures do not. The 7th character also drives payer edits and tells the next coder which character the follow-up visits need.

Full 7th character options for S72.365

For femur fractures, the Official Guidelines base the open fracture designations on the Gustilo classification. Grade I is a wound smaller than 1 cm with minimal contamination. Grade II is a larger wound with moderate soft-tissue damage. Grade III injuries have extensive soft-tissue disruption. IIIA still has adequate soft-tissue cover of the bone, IIIB needs soft-tissue reconstruction, and IIIC involves an arterial injury that needs repair. When the note does not state a Gustilo type, the guidelines assign the type I or II character, which is B.

Commonly confused codes: S72.365C vs similar S72 codes

The codes below sit closest to S72.365C and trip coders most often. Each differs by one element: the open fracture grade, displacement, laterality, or fracture pattern. Sending the wrong one to the payer means a denial and a resubmission cycle that delays payment.

S72.365C excludes notes and coding hierarchy

Category S72 carries Excludes1 and Excludes2 notes that govern when this code cannot be used and when another code may sit beside it. Ignoring them creates compliance risk and audit exposure. The CMS ICD-10 codes page provides the current tabular list where these notes appear in full.

Excludes1 (never coded together with S72.365C):

• Traumatic amputation of hip and thigh (S78.-) – when the injury is a traumatic amputation, the amputation code applies instead of the femur fracture code

Excludes2 (may be coded together when both conditions are present):

• Fracture of lower leg and ankle (S82.-) – a tibia, fibula, or ankle fracture in the same injury is coded in addition to S72.365C
• Fracture of foot (S92.-) – a foot fracture in the same injury is coded in addition to S72.365C

The practical impact: Before assigning S72.365C, confirm the fracture is traumatic in origin. The Official Guidelines send a fracture from minor trauma in a patient with known osteoporosis to category M80 instead. That question belongs on every trauma documentation checklist.

Documentation requirements for S72.365C

Medicare and commercial payers adjudicate S72.365C claims against the documentation in the medical record. Coders must code from provider documentation and cannot infer clinical findings the note does not state.

The following elements must all appear in the medical record to support S72.365C:

• Laterality: The note must state left femur, left thigh, or left side. A right-sided or unidentified side cannot support S72.365C.
• Displacement status: The physician must document “nondisplaced” or “undisplaced.” Without that statement, the guidelines default the fracture to displaced (S72.362C).
• Segmental pattern: The operative or radiology note must describe two separate fracture lines that isolate a segment of the femoral shaft. A single shaft fracture line codes elsewhere in S72.3-.
• Open fracture confirmation: The note must describe an open wound communicating with the fracture site. Do not infer it from a debridement procedure code.
• Gustilo-Anderson grade: The note must state type IIIA, IIIB, or IIIC. Type I, type II, or no documented type moves the code to S72.365B.
• Encounter type: Active treatment must be under way. Confirm the visit is not routine follow-up for a fracture that has already been treated.

Taken in order, those checks work as a decision path. The first one the record fails decides which code the claim carries instead.

Payer requirements and prior authorization

Open femoral shaft fractures are usually treated as emergencies, so surgery is rarely held for authorization. Commercial plans still differ on notification windows and on staged procedures scheduled after the index operation. Check each payer’s policy before booking planned returns to the operating room, such as definitive fixation after external fixation.

External cause codes for the mechanism, place, activity, and status of the injury describe how it happened. The Official Guidelines set no national requirement to report them. Add them where your state or payer requires them, as a secondary code after S72.365C.

Common claim denial reasons for S72.365C and how to avoid them

S72.365C claims are denied more often than coders expect because trauma codes carry more conditions than most diagnosis categories. The table below maps the common denial triggers to their corrective actions. Most clearinghouses, Claim.MD among them, run front-end edits that reject an invalid or missing 7th character before the payer sees it.

Reviewing denial management workflows for trauma cases as a standing protocol reduces rework across the S72 family. A quarterly audit of S72 denials shows which documentation element keeps going missing, so the note template or query process gets fixed first.

CPT codes commonly billed with S72.365C

Type III open femoral shaft fractures nearly always need surgery. S72.365C therefore appears beside procedure codes for open fracture debridement, internal fixation, and external fixation in staged care. The right CPT code depends on the approach and implant the operative note documents. When the note records intramedullary nailing, the procedure line is 27506.

Payer policies may restrict certain pairings, so verify the applicable MAC and commercial policies before submitting. For practices using electronic submission, the clean claim submission checklist for trauma cases should include CPT/ICD pairing as a standard step.

These pairings reflect general practice patterns. Payer policies and National Correct Coding Initiative (NCCI) edits can change which combinations clear. Verify with the AAPC Codify ICD-10-CM lookup and your payer’s policy before finalizing a pairing. Practices with high trauma volume can use medical billing denial codes to track which pairing edits trigger rejections most often.

ICD-10-CM coding guidelines applicable to S72.365C

Several sections of the ICD-10-CM Official Guidelines for Coding and Reporting bear directly on S72.365C. Review the current fiscal year version on the CMS ICD-10 codes page each October.

• Section I.C.19.c (traumatic fractures): Fractures are coded individually by site, to the detail the record supports. A fracture not documented as open or closed is coded as closed. A fracture not documented as displaced or nondisplaced is coded as displaced.
• Section I.C.19.c.1 (initial vs subsequent encounter): Use A, B, or C for every encounter where the patient receives active treatment. Once active treatment ends, routine care during healing takes a subsequent-encounter character.
• Section I.C.19.c.1 (Gustilo classification): For femur fractures, the open fracture designations follow the Gustilo classification. When the type is not specified, assign the type I or II character, which is B for an initial encounter.
• Section I.C.19.c.2 (multiple fractures): Sequence multiple fractures by severity. S72.365C covers the left femur only, so each other fracture site needs its own code.
• Section I.B.13 (laterality): If the side is not identified in the medical record, assign the code for the unspecified side, S72.366C. Query the physician first when the record suggests a side.

How Pabau supports billing for open femoral shaft fractures

In many practices, the fracture details make two trips. The surgeon writes the side, displacement, pattern, and Gustilo grade into the operative note. Days later, someone at the billing desk reads that note and picks a code. If the narrative leaves the Gustilo grade vague, the coder has to guess between B and C.

In Pabau, the clinical record and the claim sit in one system. Your team can build a trauma note form with fields for each detail S72.365C depends on. Pabau supports insurance billing and claims management in the US, UK, Australia, and Canada.

The coder reads the grade from the same record the surgeon completed, rather than from a scanned note. Every Pabau plan includes the core features, and add-ons enhance the experience, so documentation, billing, and reporting share one patient record.

Keep fracture notes and claims in one record

Pabau supports insurance billing and claims management in the US, UK, Australia, and Canada. See how your team can document trauma cases and bill complex codes like S72.365C from the same patient record.

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Conclusion

S72.365C rests on five documented facts: left side, nondisplaced, segmental pattern, open wound, and a type III Gustilo grade. Lose the grade and the claim belongs on S72.365B. Lose the displacement statement and the guidelines move it to S72.362C. The code is only as accurate as the operative note behind it, so the fix belongs at the point of documentation.

Strong trauma billing starts with the medical billing fundamentals behind every clean claim. To see how Pabau keeps the fracture note and the claim in one record, book a demo with the Pabau team.

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