ICD-10 code S72.452Q: Left femur supracondylar fracture, malunion

Key takeaways

ICD-10 code S72.452Q covers a displaced supracondylar fracture of the lower left femur, without intracondylar extension.

The 7th character Q marks a subsequent encounter for an open type I or II fracture that healed with malunion.

If the fracture line reaches the condyles, the code moves to the S72.46 family, so left-side malunion becomes S72.462Q.

A Gustilo type IIIA, IIIB, or IIIC malunion takes character R, and a closed malunion takes P.

S72.452Q is billable and valid for FY2026, which runs October 1, 2025 through September 30, 2026.

Practice management software like Pabau keeps the diagnosis code attached to the note it came from.

ICD-10 code S72.452Q is a billable ICD-10-CM diagnosis code for a distal femur fracture seen after active treatment. Its full description is a displaced supracondylar fracture without intracondylar extension of the lower end of the left femur. The 7th character Q adds the rest of the picture. It marks a subsequent encounter for an open type I or II fracture with malunion.

Every element of that description does work. The fracture is displaced, so the bone ends have shifted out of alignment. It sits above the femoral condyles and stops there, because the fracture line never reaches the joint surface.

The injury is on the left side. It was open at Gustilo type I or II severity on the day it happened. At this visit the bone has united in a faulty position, which is malunion.

One word decides half of this code. A supracondylar fracture that does extend into the condyles belongs to S72.46 rather than S72.45. The CDC/NCHS ICD-10-CM web tool confirms S72.452Q as a valid, billable code under the current tabular list.

Code details at a glance

Use the reference table below to check S72.452Q before submission. Every field in it has to match the clinical record, not just the code description.

The CMS ICD-10 code files carry the annual updates, so verify the descriptor each October. Billable status does not promise payment either, because coverage policy still varies by payer.

Anatomy of a displaced supracondylar fracture without intracondylar extension

The supracondylar region sits at the lower end of the femur, just above the two femoral condyles. A fracture there is extra-articular when the line stays above the joint. The word without in the descriptor records exactly that.

Once the fracture line runs down into the intercondylar notch or the condylar articular surface, the injury is intra-articular. ICD-10-CM moves it to a separate subcategory, S72.46. The distinction changes surgical planning as well as the code.

Displacement is the second variable. A displaced fracture means the fragments have moved out of anatomical alignment. Laterality is the third, and it is mandatory whenever the surgeon documents a side.

• Supracondylar region: lower femur, above the femoral condyles
• Without intracondylar extension: the fracture line stops short of the joint surface (S72.45)
• With intracondylar extension: the line enters the condyles, which codes to S72.46
• Displaced: fragments out of alignment, as opposed to nondisplaced (S72.455 on the left)
• Left femur: the right-side equivalent is S72.451Q

Orthopedic teams working in structured clinical records can hold the fracture pattern, the side, and the Gustilo grade in one place. That saves a coder from reconstructing the injury from a discharge summary months later.

How the 7th character works in the S72.45 group

The 7th character is the densest part of this code. It records the encounter, whether the fracture was open or closed, and how the bone has healed. Q means subsequent encounter, open type I or II, with malunion.

The S72.45 subcategory has 16 characters available. The letters I, L, and O are never used, because they read too easily as digits. The full grid below is the fastest way to land on the right letter.

Read the grid in threes and the pattern gets easy. Each healing state has one closed character and two open ones, split at Gustilo type II. Malunion runs P, Q, and R, so Q is the middle option rather than the severe one.

Gustilo classification and the character it drives

The Gustilo-Anderson system grades open fractures by wound size, contamination, and soft tissue coverage. ICD-10-CM uses that grade to pick between the two open characters in each healing state. S72.452Q applies only when the original wound was type I or II.

The surgeon assigns the grade, never the coder. Practices running documentation compliance checks can flag operative notes that record an open fracture with no grade. That query is far cheaper before submission than after a denial.

One rule saves most of these claims. The grade is set at the injury and carries forward unchanged, so a follow-up visit never re-grades the wound.

Malunion, nonunion, and delayed healing in the S72.452 family

These three healing states look similar in a chart and take three different characters. The treating provider decides which one applies, and the coder follows that statement.

Malunion means the fracture has united, but in a faulty position. The bone ends have joined and the alignment is wrong. That is the state S72.452Q reports.

Nonunion means the fracture never united within the expected timeframe, the state S72.334N reports further up the femoral shaft. Delayed healing means union is still progressing, only slower than expected. Neither one has the healed-but-crooked picture that malunion describes.

Swap the open type I or II grade for a closed fracture and the same four states become D, G, K, and P instead. Swap it for type IIIA to IIIC and they become F, J, N, and R.

Adjacent and related codes to S72.452Q

S72.452Q sits in the S72.45 subcategory, which covers supracondylar fractures without intracondylar extension. The codes nearest to it differ by one variable each. Knowing which variable moved makes the right pick obvious.

The AAPC Codify ICD-10-CM lookup is useful for confirming a descriptor before a claim goes out. For the initial-encounter end of a femur fracture, S72.041B walks through the same open-fracture logic at the first visit. Teams with claims tracking in one system can spot a pattern of sibling-code denials early.

S72.452Q in the ICD-10-CM code hierarchy

Walking the hierarchy shows why a shorter code will not do. Each level adds one clinical fact, and only the seventh character produces a submittable code.

• S00-T88 – Chapter 19, injury and poisoning
• S72 – Fracture of femur
• S72.4 – Fracture of lower end of femur
• S72.45 – Supracondylar fracture without intracondylar extension of lower end of femur
• S72.452 – Displaced supracondylar fracture without intracondylar extension of lower end of left femur
• S72.452Q – Subsequent encounter for open fracture type I or II with malunion

Note the two codes that will reject on their own. S72.45 has no laterality or displacement, and S72.452 has no 7th character. Both are header codes rather than billable diagnoses.

Follow-up for a distal femur malunion usually runs across several settings. Surgical review, imaging, and rehabilitation visits each need the same 7th character, so the healing status has to be current in the note every time.

Approximate synonyms and clinical terms

Dictated notes rarely use tabular wording. The phrases below all describe the presentation that S72.452Q reports, and none of them appears verbatim in the tabular list.

• Malunion of a displaced left supracondylar femur fracture, previously open
• Extra-articular distal femur fracture, left, healed in malalignment
• Left supracondylar femoral fracture, Gustilo grade I or II, angular deformity after union
• Healed left distal femur fracture in varus, follow-up encounter
• Left supracondylar femur fracture, open grade II, malunited
• Displaced left supracondylar femur fracture above the condyles, malunion on follow-up radiographs

Three terms look like synonyms but code elsewhere. An intercondylar or T-condylar distal femur fracture involves the joint surface and codes to S72.46. A lateral condyle fracture codes to S72.42, and a medial condyle fracture to S72.43. The same character logic follows, so a right-side medial condyle malunion after an open type III fracture is S72.431R.

Distal femoral physeal separation is a fourth trap. That injury sits in S72.44, the lower epiphysis subcategory, even though clinicians often describe it as a distal femur fracture.

Sequencing rules for a subsequent fracture encounter

Follow-up fracture care has its own sequencing conventions in the ICD-10-CM Official Guidelines. Getting them wrong is a common source of rejected orthopedic claims, even when the fracture code itself is correct.

• Do not use an aftercare Z code for fracture follow-up, and report the injury code with a subsequent-encounter 7th character instead
• Sequence the fracture code first, then any external cause code from Chapter 20 as a secondary code
• Carry the Gustilo grade documented at the injury forward to every later encounter
• Keep laterality identical across encounters, because a switched side reads as a new injury
• Reserve S72.452S for a late effect, and code the residual condition first

External cause reporting is not optional in every state or payer contract, so check local requirements. The same chapter-level conventions govern the head injuries that often accompany a high-energy femur fracture, including S06.6X1D. When the injury has resolved into a residual deformity, S72.411S shows how the sequela character behaves.

Documentation requirements for S72.452Q

Six facts must appear in the record before this code is safe to assign. Miss one and the coder either queries the provider or drops to a less specific code.

• Laterality: documented as the left femur
• Fracture site: supracondylar, with a statement that the line does not extend into the condyles
• Displacement: confirmed as displaced rather than nondisplaced
• Open fracture grade: Gustilo type I or II, recorded by the treating surgeon at the injury
• Encounter type: a follow-up visit after active fracture treatment has finished
• Healing status: malunion stated by the provider, not inferred from an imaging report

The cheapest place to fix this is the first encounter. Custom clinical forms can require the side, the displacement, and the open fracture grade before the note can be signed. Every later visit then inherits facts that a coder would otherwise chase.

CPT codes commonly paired with ICD-10 code S72.452Q

A documented malunion usually brings either corrective surgery or continued follow-up. The procedures below are the ones that most often appear on a claim alongside this diagnosis.

The diagnosis code never justifies the procedure code on its own. Payer edits still test whether the operative note supports the work billed, so check each contract. Orthopedic and sports medicine practices that scrub claims before submission catch most of these mismatches in-house.

Common coding errors to avoid

Five mistakes account for most inaccurate S72.452Q claims. Each one is catchable in the chart before submission.

1. Coding an intra-articular fracture to S72.45

This is the error worth checking first. S72.45 is the without intracondylar extension subcategory, so it never fits a fracture that reaches the joint surface. When the operative note describes an intercondylar split, the left-side malunion code is S72.462Q.

2. Using Q for a Gustilo type III malunion

Q stops at type II. A malunion after a type IIIA, IIIB, or IIIC open fracture takes R, which gives S72.452R on the left. Trace the grade back to the original operative report rather than the follow-up note.

3. Using an open fracture character on a closed injury

Closed fractures have their own characters in every healing state. A closed left supracondylar fracture that heals in malalignment is S72.452P, not S72.452Q. Nothing in the follow-up note will flag the difference, so the injury record has to.

4. Reading delayed healing or nonunion as malunion

Malunion means the bone has united in the wrong position. Delayed healing takes H and nonunion takes M for the same open grade. If the note is ambiguous about union, query the provider instead of choosing.

5. Using a subsequent character at an initial visit

Q describes a follow-up encounter. It cannot report the visit where the fracture is first treated, debrided, or fixed. Those encounters take a character from the A to C range, with B covering an open type I or II injury.

Each of these five is a documentation problem before it is a coding problem. A coder who can see the injury record and the follow-up note on one screen avoids all five.

How Pabau keeps subsequent-encounter coding accurate

In most orthopedic practices the fracture detail and the claim live in different systems. A coder reads the operative report, finds the Gustilo grade, then retypes a code into a billing screen. Each retype is another chance to lose the 7th character.

Practice management software like Pabau closes that handoff. The clinician records the fracture in a structured note, and the diagnosis code selected there travels with the claim. Nobody reconstructs the original grade from a discharge summary months later.

That matters on a code like S72.452Q, where one letter separates malunion from nonunion. Required form fields can hold laterality, displacement, and open fracture grade from the first visit onward. Your team raises a query that week instead of working a denial next quarter.

Keep fracture codes tied to the clinical note

Pabau holds laterality, displacement, and open fracture grade in structured notes, then carries the diagnosis code your clinician selects through to the claim.

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Conclusion

S72.452Q rewards practices that get the operative note right the first time. When the record names the side, the displacement, the fracture line, and the Gustilo grade, the follow-up code follows in seconds.

The trap in this code is the word without. A fracture line that reaches the condyles belongs to S72.46. A type III open injury takes R rather than Q, and neither error looks wrong on a claim form. Both surface at audit.

So build those four facts into the fracture template and let every later code inherit them. Book a demo to see how Pabau keeps diagnosis codes attached to the documentation they came from.

Continue your research

Coding the same femur fracture at the first visit? ICD-10 code S72.041B covers the initial encounter for an open type I or II femur fracture.

Reporting a femur fracture years after the injury? ICD-10 code S72.411S explains how the sequela character works and what it needs in the note.

Need the nonunion code in the same subcategory? ICD-10 code S72.451K covers a right-side supracondylar fracture that failed to unite after a closed injury.

Seeing the same malunion character on another bone? ICD-10 code S42.012P shows how character P works on a displaced left clavicle fracture.

Coding a knee-region injury that healed into a deformity? ICD-10 code S82.036S covers the sequela of a nondisplaced transverse patella fracture.

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