ICD code S72.452C – Displaced supracondylar fracture of left femur

Key takeaways

S72.452C codes an open, displaced supracondylar fracture of the left femur with no intracondylar extension. It is billable in the current ICD-10-CM code set.

Seventh character C means an initial encounter for a Gustilo type IIIA, IIIB, or IIIC open fracture. Type I or II uses B, and a closed fracture uses A.

The record must state the side, the supracondylar site, open status, and a type III Gustilo grade. With no grade stated, the guidelines assign B, not C.

Open treatment of this fracture usually pairs with CPT 27511. A fracture that splits between the condyles is S72.462C and pairs with CPT 27513.

Pabau’s claims management software submits S72.452C claims electronically through its Claim.MD integration.

ICD-10 code S72.452C: Definition, billable status, and code hierarchy

ICD-10 code S72.452C is a valid, billable ICD-10-CM diagnosis code, listed in the CDC/NCHS ICD-10-CM web tool. Officially, it reads: Displaced supracondylar fracture without intracondylar extension of lower end of left femur, initial encounter for open fracture type IIIA, IIIB, or IIIC.

The code sits in chapter 19 (S00-T88, injury, poisoning and certain other consequences of external causes). Within that chapter it falls in block S70-S79 (injuries to hip and thigh), category S72 (fracture of femur), and subcategory S72.45. The sixth character 2 marks the left side.

The quick-reference table below shows S72.452C alongside its closest sibling codes.

S72.452 covers a fracture above the femoral condyles that does not extend into the joint between them. Coders often confuse it with the condyle codes, S72.42- (lateral condyle) and S72.43- (medial condyle). It is also easy to miss an intracondylar split, which moves the fracture to S72.46-.

Anatomy: The supracondylar femur and what “displaced” means

The supracondylar region is the distal femoral metaphysis, the flared lower end of the femur just above the medial and lateral condyles. A fracture here sits between the shaft and the knee joint surface. In younger adults it usually follows high-energy trauma, such as a motor vehicle collision or a fall from height.

That high-energy pattern is why open Gustilo type III injuries are common at this site. “Without intracondylar extension” means the fracture line stays above the condyles. It does not run down between them into the knee joint.

“Displaced” means the fracture fragments have shifted out of anatomical alignment. Nondisplaced fractures of the left side use S72.455-, a separate code family. The official guidelines code a fracture to displaced when the record does not say either way.

• Supracondylar vs condylar: S72.45- codes a fracture above the condyles. A fracture of one condyle is S72.42- (lateral) or S72.43- (medial).
• Without vs with intracondylar extension: S72.45- has no split between the condyles. A supracondylar fracture that extends between them is S72.46-.
• Displaced vs nondisplaced: S72.451 to S72.453 are displaced (right, left, unspecified side). S72.454 to S72.456 are the nondisplaced versions.
• Lower end vs shaft vs neck: S72.452 is a lower-end fracture. Femoral shaft fractures are S72.3-, and femoral neck fractures are S72.0-.

Seventh character system for S72.452: Full table of valid characters

ICD-10-CM S72.452 requires a seventh character on every claim. The character encodes both the fracture type (open or closed) and the encounter stage (initial, subsequent, or sequela). Per the CMS ICD-10-CM guidelines, Section I.C.19.c, coders choose it from the medical record, not from an assumed encounter type.

Gustilo-Anderson classification: How open fracture grade maps to the seventh character

The Gustilo-Anderson classification, first published in the Journal of Bone and Joint Surgery in 1976, grades open fractures by wound size, contamination, and soft-tissue damage. ICD-10-CM uses this grading directly to decide whether seventh character B or C applies.

The Gustilo grade is a clinical call made by the treating surgeon at initial evaluation or surgery. Coders assign C only when the emergency or operative report documents type IIIA, IIIB, or IIIC. When an open fracture has no documented grade, the guidelines assign the type I or II character, B.

S72.452C vs S72.452A and S72.452B: Choosing the right initial encounter code

All three initial encounter characters describe the same fracture site, side, and displacement. They differ only in whether the fracture is open and, for open fractures, its Gustilo grade. Getting this choice wrong is the most common S72.452 denial trigger.

Check the AAPC ICD-10-CM code lookup for the full descriptor and any guideline notes for the current code year.

Subsequent encounter and sequela codes for S72.452

Seventh character C applies to every encounter where the patient receives active treatment for the fracture. Once active treatment ends, the code switches to a subsequent encounter character for routine care during healing. The switch depends on clinical status, not on time elapsed.

• F: Use for follow-up visits where the open type IIIA, IIIB, or IIIC fracture is healing as expected.
• J: Use when healing is delayed at a subsequent encounter for an open type III fracture.
• N: Use when the type III open fracture has progressed to nonunion.
• R: Use when malunion is documented for a type III open fracture.
• S: Use for a late effect of the original fracture, such as post-traumatic arthritis, once the acute phase is over.

Aftercare Z codes such as Z47.89 are not used for traumatic fractures. Section I.C.19.c.1 of the guidelines tells coders to keep the acute fracture code with the right seventh character instead. Follow-up care for this fracture therefore stays on S72.452 with F, J, N, R, or S.

Documentation requirements for assigning S72.452C

Section I.C.19.c says fracture codes follow the level of detail in the medical record. For S72.452C, the record must support all six elements below. Maintaining medical billing compliance starts with an operative note that covers each one before the claim goes out.

1. Fracture site: The record must place the fracture in the supracondylar region of the distal femur. A note that only says “distal femur fracture” or “knee fracture” needs clarifying.
2. No intracondylar extension: Imaging or the operative note must show the fracture stays above the condyles. An intercondylar split moves the code to S72.462C.
3. Displacement status: Document displaced or nondisplaced. A nondisplaced left-side fracture is S72.455C, and an unstated status defaults to displaced.
4. Open fracture designation: The record must state the fracture is open, not just that a wound is present. A fracture not described as open or closed is coded as closed.
5. Gustilo grade: The treating surgeon must state type IIIA, IIIB, or IIIC. A coder cannot assign the grade, and an open fracture with no grade defaults to B.
6. Laterality: The note must name the left femur. The right side is S72.451C, and S72.453C covers an unspecified side.

The record must also support initial encounter status. That usually means the emergency visit, the operative note, or another encounter for active fracture treatment. The decision path below runs those checks in order and shows which code each failed check points to instead.

External cause and laterality codes

External cause codes from chapter 20 describe how the injury happened. Section I.C.20 of the guidelines says there is no national requirement to report them. Report them when the record documents the cause, unless a payer or a state mandate requires them anyway.

Laterality is built into the code itself. In S72.45-, the sixth character marks right (1), left (2), or unspecified (3) for displaced fractures. S72.452C billed for a right-sided fracture is a documentation mismatch that payers flag on audit.

CPT codes commonly paired with S72.452C

The CPT code on a claim must match the procedure documented in the operative report. The diagnosis code does not decide which CPT applies. Even so, open type III supracondylar fractures are usually debrided and then fixed, either with open reduction and internal fixation or with external fixation first.

Check NCCI edits before billing debridement alongside fixation on the same claim. Confirm each procedure descriptor in a current CPT code reference before you pair it with S72.452C. Verify current reimbursement against the CMS Physician Fee Schedule lookup, as RVU-based rates update every year.

Payer requirements: Medicare and commercial insurers

Medicare pays for S72.452C fracture care under standard Part A and Part B rules, and the fracture repair CPT carries a 90-day global period. Understanding medical billing fundamentals for trauma cases helps orthopedic billing teams prepare claims that pass first review. The electronic remittance advice returned after adjudication shows the CARC code behind any rejection.

• Medical necessity: The operative report is not sent with every claim, but it must support the procedure if the payer reviews it. For open type III fractures, the injury itself usually establishes the need for surgery.
• Prior authorization: Emergency trauma repairs typically do not need prior authorization. Planned revision surgery for nonunion or malunion may need it from Medicare Advantage plans and commercial insurers.
• Medicaid: Requirements vary by state. Some state programs require prior authorization for planned fracture surgery, so check the state Medicaid rules before submission.
• Commercial insurers: Each payer sets its own policy, including whether external cause codes are required. Check current policies directly with each payer.

Common claim denial reasons for S72.452C and how to avoid them

Open fracture claims need more documentation detail than closed fracture claims, so they fail more often. Effective denial management workflows for orthopedic practices start with a pre-submission check of the points below. A clean claim submission the first time avoids the revenue delays of an appeal.

Codes related to and excluded from S72.452C

S72.452C inherits tabular notes from the S72 category and the S72.4 subcategory. They decide which codes may sit alongside it on the claim.

• S72 Excludes1: Traumatic amputation of hip and thigh (S78.-). The two are never coded together.
• S72 Excludes2: Fracture of lower leg and ankle (S82.-), fracture of foot (S92.-), and periprosthetic fracture of a prosthetic hip implant (M97.0-). These may be reported alongside S72.452C when both injuries are present.
• S72.4 exclusions: Fracture of the femoral shaft (S72.3-) and physeal fracture of the lower end of the femur (S79.1-). A growth-plate fracture in a child goes to S79.1-.

The table below covers the neighbor codes most often confused with S72.452C and when each applies instead.

During physical therapy and other rehabilitation after this fracture, subsequent encounter characters (F, J, N, R) govern the coding. The initial encounter character C no longer applies.

How Pabau keeps S72.452C claims clean

An open supracondylar fracture claim passes through several hands. The surgeon dictates the operative note, and a coder reads it for side, fracture pattern, and Gustilo grade. A biller then builds the claim, and each handoff can turn left into right or C into B.

Pabau, the practice management and billing platform we build, handles electronic claims submission via Claim.MD. The integration connects Pabau’s claims management software to a US clearinghouse reaching thousands of payers. Built-in CPT and ICD-10 catalogs help your team check code pairings before a claim goes out.

Remittance advice comes back into Pabau as well, so a denial reason sits beside the claim it belongs to. Your billing team can trace a rejected S72.452C claim back to the operative note behind it. Fixing that note template stops the same denial from returning on the next claim.

Streamline orthopedic billing with Pabau

Pabau integrates with Claim.MD to submit S72.452C claims electronically, with CPT and ICD-10 catalogs built in. See how orthopedic and multi-specialty practices manage complex fracture billing.

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Conclusion

S72.452C is correct only when the record supports a precise set of facts. The fracture sits above the left femoral condyles with no split between them. It is displaced and open, and the surgeon graded it Gustilo type IIIA, IIIB, or IIIC. Change any one fact and a different code applies, such as S72.451C, S72.462C, or S72.452B.

The most reliable fix sits upstream of coding. An operative note template that asks for side, intercondylar extension, and Gustilo grade removes most of the queries this code generates. Pabau then carries the coded encounter into a Claim.MD submission with CPT and ICD-10 catalogs built in. See how it handles orthopedic trauma billing by booking a demo.

Continue your research

Need to understand how claims get processed after submission? Medical claims clearinghouse guide explains how electronic claims move from practice to payer and where they can fail.

Looking for guidance on coding denial codes on the remittance? Denial codes in medical billing covers the most common CARC and RARC codes you will see on rejected fracture claims.

Want to understand how eligibility checks prevent claim rejections? Insurance eligibility verification outlines how real-time eligibility checks flag inactive or lapsed coverage before a claim is submitted.

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