ICD code S72.446E – Nondisplaced fracture of lower epiphysis (separation) of unspecified

Key takeaways

ICD-10 code S72.446E describes a nondisplaced fracture of the lower epiphysis (separation) of an unspecified femur. It applies at a subsequent encounter for an open type I or II fracture healing routinely.

The sixth character 6 means the side was never documented. Use S72.444E for the right femur or S72.445E for the left whenever the record names a side.

S72.446E is a billable ICD-10-CM code, valid for fiscal year 2026 and effective October 1, 2025. It is exempt from present-on-admission reporting.

S72.44 and S72.43 are easy to swap. A nondisplaced medial condyle fracture of the left femur is S72.435E, not S72.446E.

Pabau’s claims management software integrates with Claim.MD to validate ICD-10 diagnostic codes before submission, reducing denials caused by incorrect encounter characters or missing laterality.

S72.446E code details at a glance

The table below summarizes the reference facts for ICD-10 code S72.446E as published in the 2026 ICD-10-CM tabular list.

Code hierarchy: Where S72.446E sits in ICD-10-CM

ICD-10 code S72.446E belongs to a well-defined hierarchy in the CMS ICD-10-CM code set. Reading the parent-to-child path is the fastest way to check that a suggested code really matches the documented site.

The S72.4 subcategory covers the lower (distal) end of the femur only. That separates these injuries from femoral neck fractures (S72.0), intertrochanteric fractures (S72.1), and subtrochanteric fractures (S72.2). Inside S72.4, the fifth character names the part that broke.

• S72.41: Unspecified condyle fracture of lower end of femur.
• S72.42: Fracture of lateral condyle of femur.
• S72.43: Fracture of medial condyle of femur.
• S72.44: Fracture of lower epiphysis (separation) of femur, where S72.446E sits.
• S72.45 and S72.46: Supracondylar fracture without and with intracondylar extension.

S72 runs unusually deep for a fracture category. Site, displacement, side, and encounter each get their own character position, so one mistyped digit changes the documented diagnosis. The breakdown below maps each character of S72.446E to the fact in the record it stands for.

Clinical definition: Nondisplaced fracture of the lower epiphysis of the femur

The lower epiphysis of the femur is the bone segment at the distal end, beyond the growth plate. It forms the upper half of the knee joint. A separation means that segment has parted from the shaft along or close to the physis. The fracture line runs through the epiphyseal region rather than through a single condyle.

These injuries take considerable force. A fall from height, a motor vehicle collision, or a valgus or hyperextension load at the knee will all do it. The pattern is most common in adolescents, whose distal femoral physis has not yet closed. Pediatric and sports medicine records carry a large share of these injuries.

Nondisplaced means the bone has cracked or separated but the fragments remain in anatomical alignment. The distinction drives the code, because ICD-10-CM splits displaced from nondisplaced throughout the S72 family. The tabular note at S72 is blunt about the default: a fracture not indicated as displaced or nondisplaced is coded to displaced.

That default has a practical consequence. If the radiology report never uses the word nondisplaced, S72.446 is the wrong stem, and the claim should carry a displaced code instead.

• Nondisplaced, side not documented: S72.446, plus the applicable 7th character.
• Displaced, side not documented: S72.443, plus the applicable 7th character.
• Right femur: S72.444 if nondisplaced, S72.441 if displaced.
• Left femur: S72.445 if nondisplaced, S72.442 if displaced.
• Both femurs: No bilateral code exists here, so assign a separate code for each side.

The tabular list also treats open and closed the same way. A fracture not indicated as open or closed is coded to closed, and the open fracture designations follow the Gustilo classification.

Two codes that get mistaken for S72.446

S72.446 has two close neighbors that produce the wrong claim rather than a rejected one. One is the medial condyle group at S72.43. The other is the Salter-Harris physeal group at S79.1.

Medial condyle (S72.43) and lower epiphysis (S72.44)

Both sub-subcategories sit under S72.4, both carry nondisplaced stems, and both use the same laterality order. Only the fifth character tells them apart, so a mistyped digit changes the documented site without changing anything else about the code.

The table exposes the trap immediately. A nondisplaced medial condyle fracture of the left femur at a subsequent open type I or II encounter is S72.435E, not S72.446E. Any tool that suggests a code from a text string needs a coder to confirm the site against the imaging report.

Salter-Harris physeal fractures belong in S79.1

An Excludes1 note at S72.44 bars Salter-Harris Type I physeal fracture of the lower end of the femur (S79.11-) from ever being coded here. One level up, S72.4 carries an Excludes2 note for physeal fracture of the lower end of the femur (S79.1-).

Read together, the two notes send any graded physeal fracture to S79.1 and leave S72.44 for an epiphyseal separation the record does not grade. If the operative note or radiology report names a Salter-Harris type, the code comes from this group instead.

• S79.11: Salter-Harris Type I physeal fracture of lower end of femur.
• S79.12: Salter-Harris Type II physeal fracture of lower end of femur.
• S79.13: Salter-Harris Type III physeal fracture of lower end of femur.
• S79.14: Salter-Harris Type IV physeal fracture of lower end of femur.
• S79.19: Other physeal fracture of lower end of femur.

The 7th character E: Subsequent encounter

The 7th character in ICD-10 code S72.446E is the most consequential element for billing. The letter E designates a subsequent encounter for an open fracture type I or II with routine healing. Under the ICD-10-CM Official Guidelines, subsequent encounters cover every visit after the initial treatment while active care continues.

Three facts combine to produce the E qualifier. First, this is a subsequent encounter, not an initial visit or a sequela. Second, the underlying fracture was open type I or II. Third, healing is progressing normally, with no delayed union, nonunion, or malunion documented. Change any one of the three and a different 7th character applies.

HIPAA mandates ICD-10-CM for every covered entity, so the encounter character carries the same weight in every specialty. Submitting an initial-encounter code on a follow-up visit, or a subsequent-encounter code on a first visit, is an error payers actively audit.

Open fracture classification: Type I and type II

ICD-10 code S72.446E is tied to open fractures classified as Gustilo type I or type II. The Gustilo-Anderson classification is the standard orthopedic grading system for open fractures, separating them by wound size, contamination level, and soft-tissue damage.

The split between type I/II and type IIIA, IIIB and IIIC drives different 7th character values across the whole S72 family. A type IIIA fracture that heals routinely uses F, not E. Conflating the two is a documented source of claim denials in orthopedic billing.

Full list of 7th character extensions for S72.446

S72.446 is the code stem for a nondisplaced fracture of the lower epiphysis (separation) of an unspecified femur. Every valid 7th character extension produces a separate billable code. The table below covers all sixteen of them.

Reach for unspecified laterality only when the record forces it

S72.446E is a valid code, but it should be the last one you choose. The sixth character is the laterality position, and 6 states that the documentation never named a side. That is a fact about the record, not a fact about the patient.

Every distal femur has a side, so an unspecified code on a paired bone reads to a payer as incomplete documentation. Medical-necessity review and duplicate-claim edits both lean on laterality. A follow-up series coded S72.446E at every visit gives the reviewer nothing to match against the initial encounter.

The side is usually already in the chart. Check the initial radiology report, the operative note, the triage note, and the therapy plan of care. Do that before you settle for the x6 stem, because one provider query resolves most of these claims.

Unspecified laterality is still legitimate in a narrow set of situations. Outside records may arrive with the side missing, an image may be unread, or a transfer may land with no usable documentation at all. In those cases, record that the query happened so an auditor can see the reasoning behind the code.

Related codes in the S72.44 family

S72.446E belongs to the S72.44 sub-subcategory, which covers fractures of the lower epiphysis of the femur only. Six stems split that group by displacement and side. Confirm both from the source documentation, then check the stem you picked against our wider ICD-10-CM code library.

For reference, verify any related code against the 2026 ICD-10-CM listing for S72.446E. It mirrors the official CMS and NCHS files and is updated each fiscal year.

ICD-9-CM crosswalk for S72.446E

The 2026 CMS General Equivalence Mappings convert S72.446E to a single legacy code: V54.15, aftercare for healing traumatic fracture of upper leg. That one mapping says a lot about how the two code sets differ.

ICD-9-CM had no way to carry the encounter inside the injury code. A follow-up visit therefore moved to an aftercare V code. That code described the care but dropped the site detail, the displacement, and the open fracture grade. ICD-10-CM folds all of it into one code by using the 7th character.

That matters for trend reporting. Volumes built on V54.15 will never line up cleanly with volumes built on S72.446, because the old code pooled every healing upper-leg fracture. Treat the mapping as a rough bridge for legacy data, not a substitute for coding from the record.

Billing and reimbursement for S72.446E

S72.446E is billable and specific, so it goes on a claim without a more detailed companion code. On an inpatient claim it groups to MS-DRG 559, 560 or 561, all three of which cover aftercare for the musculoskeletal system and connective tissue. Which one applies depends on whether an MCC or a CC is also reported.

The code is exempt from present-on-admission reporting, so no POA indicator is required. Two chapter-level instructions still apply. Chapter 20 asks for a secondary external cause code to explain the injury. The S00-T88 note asks for an additional code to identify any retained foreign body (Z18.-).

Documentation requirements

Five documented elements decide whether this code survives review. Each one maps to a character position or a payer edit.

• Site: A separation of the lower epiphysis, stated clearly enough to rule out a condyle fracture or a graded physeal fracture.
• Displacement: The word nondisplaced, since anything silent defaults to displaced.
• Laterality: Right or left, or a recorded query showing the side could not be established.
• Encounter type: Evidence that this visit follows the initial treatment and active care continues.
• Wound and healing status: An open type I or II wound, with healing described as routine.

Common coding errors on S72.446E claims

Errors on S72.446E claims fall into five predictable patterns. Catching each one at documentation capture prevents the rework. Orthopedic practices trace much of their denial management workload back to these five points.

• Site swapped with the medial condyle: S72.446E is a lower-epiphysis separation. A nondisplaced medial condyle fracture of the left femur is S72.435E. Check the fifth character against the imaging report before you accept a suggested code.
• Unspecified laterality left in place: The x6 stem is a default, not a finding. Query for the side and move the claim to S72.444 or S72.445 whenever the answer comes back.
• Initial and subsequent encounters mixed up: Using S72.446E on a first visit, or the initial-encounter code S72.446B on a follow-up, triggers an edit. The encounter character has to match the visit type in the record.
• Open fracture type confusion: Selecting E when the operative note documents type IIIA is a substantive error. Types IIIA, IIIB, and IIIC use F for a subsequent encounter with routine healing.
• Healing status assumed: E requires routine healing. If the provider documents delayed union, nonunion, or malunion, the 7th character moves to H, M, or Q. Coders cannot infer routine healing from silence.

Every one of these five errors is auditable. CMS and commercial payers run coding edit software that flags fracture codes where the encounter character conflicts with the episode timeline on record.

How Pabau supports accurate ICD-10 diagnostic coding

Orthopedic and physical therapy teams see dozens of fracture follow-up visits per provider each week. Each one needs a correct 7th character, a confirmed side, and a documented healing status. Pabau is practice management software for medical and aesthetic practices. Its clinical documentation tools capture that encounter context at the point of care, so the coder works from what the provider recorded.

Pabau integrates with Claim.MD, a US medical claims clearinghouse that connects to thousands of payers. A claim carrying ICD-10 code S72.446E goes out through that connection. The clearinghouse runs eligibility checks and validates the code set before transmission. Rejections caused by a wrong encounter character or a mismatched open fracture type surface there, before the payer opens an adjudication queue.

For practices managing high volumes of fracture follow-ups, Pabau’s claims management software tracks denial reasons per code. Coders can then spot patterns such as repeated E-versus-F confusion, or a provider whose notes omit laterality. The fix lands on the source rather than on the claim, and the pattern data feeds coding education directly.

Reduce coding denials with Pabau

Pabau integrates with Claim.MD to validate ICD-10 diagnosis codes before submission. Orthopedic and physical therapy practices catch missing laterality, wrong encounter characters, and open-fracture type mismatches before they reach the payer.

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Conclusion

ICD-10 code S72.446E is precise about three things and silent about one. It describes a nondisplaced separation of the lower femoral epiphysis, seen at a subsequent encounter, with an open type I or II wound healing routinely. What it does not say is which leg.

That silence is the part worth acting on. When the record names a side, S72.444E or S72.445E carries the same clinical picture with none of the audit exposure. Save S72.446E for the claim where a provider query has already come back empty. Keep the fifth character honest too, so a condyle fracture never lands here.

For practices that want clean claims on the first submission, Pabau validates ICD-10 diagnostic codes before they reach the payer. Book a demo to walk through the documentation and billing workflow behind a fracture follow-up claim.

Continue your research

Coding a medial condyle fracture instead? ICD-10 code S72.436C covers the S72.43 site that gets swapped for the lower epiphysis most often.

Does the record say displaced rather than nondisplaced? ICD-10 code S72.442C is the displaced left-femur stem inside the same S72.44 group.

Has the report graded a Salter-Harris type? ICD-10 code S79.141A shows where a graded physeal fracture of the distal femur belongs.

Working through rejections on fracture claims? Denial management in healthcare explains how to reduce rejections from encounter-type errors and coding mismatches.

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