ICD code S72.461Q – Displaced supracondylar right distal femur fracture with intracondylar extension

Key takeaways

S72.461Q is a billable FY2026 ICD-10-CM code, valid for HIPAA-covered transactions effective October 1, 2025.

The code describes a displaced supracondylar fracture of the right distal femur that extends into the joint between the condyles.

The 7th character Q means a subsequent encounter for an open fracture of Gustilo type I or II that has healed in malunion.

Documentation must confirm laterality, intracondylar extension, displacement, open fracture status, and a physician-stated malunion.

Practice management software like Pabau keeps these documentation details attached to the encounter, so coders are not chasing them later.

ICD-10 Code S72.461Q: Code at a glance

ICD-10 Code S72.461Q reports a displaced supracondylar fracture of the lower end of the right femur, extending between the condyles.

The 7th character Q marks a subsequent encounter for an open fracture of Gustilo type I or II. That fracture has healed in malunion.

The code is billable and specific, valid for the FY2026 edition effective October 1, 2025. It is accepted on HIPAA-covered transactions and needs no characters beyond the 7th already present.

Full code description: Breaking down each component

Every phrase in the descriptor encodes a clinical fact the record has to support. The table below takes the descriptor apart term by term, so you can check your notes against each element before you assign the code.

Two components are never assumed. The record has to show that the fracture was open, and a physician has to state the malunion. Intracondylar extension is the third element worth double-checking. It separates S72.461 from the S72.451 series, which covers supracondylar fractures that stop short of the joint.

Understanding the 7th character Q in the S72.461 family

The 7th character on an S72.461 code carries three facts at once. It records the encounter type, the open or closed status of the original fracture, and the healing outcome. Sixteen values are valid across this family, and the open fracture characters split by Gustilo severity rather than by a simple open-or-closed choice.

Q and P are the two malunion characters for a right-sided S72.461 fracture. They differ on one point only: whether the original fracture was open. Assign Q when the record documents an open fracture of Gustilo type I or II, and P when the fracture was closed.

Two facts in the record decide the character: whether the wound was open and graded, and how the bone healed. The grid below crosses those two axes, so you can land on the letter without scanning all sixteen rows.

The set skips the letters I, L, and O on purpose, so a character can never be mistaken for a numeral.

S72.461Q in the S72 code hierarchy

S72.461Q sits at the most granular level of the femur fracture classification tree. Tracing its parents helps you confirm the subcategory before you add the 7th character. The full set of parents and siblings is indexed in the ICD-10-CM code library.

S72.4 covers the lower end of the femur only. A fracture of the femoral shaft belongs to a different subcategory, S72.3. A displaced comminuted shaft fracture on the right side is S72.351, not S72.461. Confirm the fracture site in the imaging or operative report before you settle on the subcategory.

Open fracture type I or II: What the Gustilo grade does to this code

Character Q depends on the Gustilo-Anderson grade recorded for the original wound, so that grade drives the code. Types I and II share one group of characters. Types IIIA, IIIB, and IIIC share another.

ICD-10-CM carries a default here that saves a lot of provider queries. Where the record documents an open fracture but names no Gustilo grade, the official guidelines direct you to the type I or II characters. A malunion on an open fracture of unstated grade therefore lands on Q, not R.

That default runs one way only. A record that never says whether the fracture was open is coded as closed, which moves the malunion to S72.461P. So the wound description in the emergency department note decides between two codes that look almost identical on a claim form.

Malunion vs. nonunion: Coding the difference for S72.461

Malunion and nonunion are the two complications most often swapped on distal femur claims, and they take different 7th characters. Malunion means the fracture united, but in a mechanically or anatomically poor position. Nonunion means it never united inside the expected healing window.

Neither finding is a coder inference. Both need an explicit physician diagnosis backed by imaging. Where a note says only that the fracture is not healing well, query the provider before you assign Q or M.

Related codes in the S72.461 family

Every code below shares one base descriptor: displaced supracondylar fracture with intracondylar extension of lower end of right femur. Only the 7th character changes, so the sibling table is really a map of encounter and healing status. Verify the current list through the CDC ICD-10-CM web tool or the AAPC Codify ICD-10 lookup before billing.

Five neighboring base codes are easy to confuse with S72.461, because their descriptors differ by a single element:

• S72.462Q and S72.463Q carry the same fracture and encounter on the left femur and on an unspecified femur.
• S72.464Q is the nondisplaced version on the right side, used only where the record states nondisplaced.
• S72.451Q covers a displaced supracondylar fracture of the right femur without intracondylar extension, so the joint surface is spared.
• S72.351Q sits in a different subcategory altogether: a displaced comminuted fracture of the shaft of the right femur.

When to use subsequent encounter codes for distal femur fractures

According to the CMS ICD-10-CM guidelines, the encounter type drives the 7th character across the whole healing journey, not just the first few visits. Coders new to fracture coding often drop the A character too early, or switch to a subsequent character while active treatment is still running. The official definitions work like this:

• Initial encounter (A, B, C): The patient is receiving active treatment for the fracture. That covers the first visit, and also any later visit where active treatment is delivered, such as a second procedure or a new cast. It does not end simply because weeks have passed.
• Subsequent encounter (D through R): Active treatment has finished and the patient is in routine recovery care. The character reflects the healing status at this visit, not the status at the time of injury.
• Sequela (S): Used for a late effect of the fracture once healing is complete. The sequela code is sequenced after the code for the condition the sequela produced.

For S72.461Q, the subsequent encounter designation confirms two facts at once. The patient is past the acute phase, and the distal femur has united in an abnormal position. Every visit in this phase keeps Q until the clinical picture changes or the malunion is reclassified.

ICD-10-CM coding guidelines for distal femur fractures

ICD-10-CM Official Guidelines Section I.C.19.c governs fracture coding across the S72 category. Three defaults apply when documentation is thin, and each one moves S72.461Q by a letter or a subcategory.

• Default: displaced. Where the record does not say whether the fracture is displaced, the guidelines direct you to the displaced code. S72.461Q therefore wins over S72.464Q when displacement is unstated.
• Default: closed. Where the record does not say whether the fracture is open or closed, code it as closed. A malunion then takes S72.461P instead of Q.
• Default: open type I or II. Where the fracture is documented as open but ungraded, assign the type I or II character. That is what makes Q the landing spot for most ungraded open distal femur malunions.
• Intracondylar extension is not defaulted. If the report describes a supracondylar fracture without mentioning extension into the joint, S72.461 does not apply.
• Laterality is not defaulted. Where the note is silent or ambiguous about which femur, query the provider rather than reaching for the unspecified code.

Applying these defaults consistently, and recording your rationale when you invoke one, is what makes the assignment defensible. Payer auditors regularly scrutinize laterality and encounter-type assignments on high-cost orthopedic claims.

Documentation requirements for S72.461Q

A claim for S72.461Q stands up to audit only when the clinical record supports every coded element. One missing component is enough to justify a payer denial.

Practices running audit-ready claims management can build pre-submission documentation checks into the coding workflow. A thin note is then caught before the claim leaves the practice.

• Laterality confirmed: The note states right femur or right distal femur explicitly. A generic femur fracture entry fails this requirement.
• Fracture site documented: The record places the fracture at the lower end of the femur, in the supracondylar region, rather than in the shaft.
• Intracondylar extension documented: Imaging or the operative report describes the fracture line running between the condyles and into the joint surface.
• Displacement confirmed or defaulted: The record states displaced, or you have applied the displaced default and noted the basis for doing so.
• Open fracture documented: A wound over the fracture site is described. If a Gustilo grade is recorded, it must be type I or II for Q to apply.
• Encounter type established: The visit note confirms the patient has finished active treatment and is in the recovery phase.
• Malunion explicitly diagnosed: The physician states malunion as a diagnosis or a confirmed finding. An imaging report alone, with no clinician interpretation, will not support the code.

Work through that checklist before the claim leaves the practice, and it goes out as a clean claim. A rejection that lands later almost always traces back to one of those seven lines.

Related CPT codes for distal femur fracture treatment

S72.461Q is a diagnosis code. The procedure codes billed alongside it depend on what was done at the encounter. The CPT codes below are the ones most often paired with a supracondylar distal femur fracture and its complications.

Two shaft codes turn up in the wrong place often enough to be worth naming. CPT 27506 covers open treatment of a femoral shaft fracture with an intramedullary implant. CPT 27507 covers the same shaft fracture treated with a plate and screws. Neither pairs with S72.461Q, because the shaft is a different anatomical site.

One spelling trap sits between the two code sets. ICD-10-CM writes intracondylar extension, while CPT writes intercondylar extension. Both describe a fracture line running into the joint surface. An encoder search on one spelling can hide the matching code in the other system.

Verify current-year descriptors against the AMA CPT edition your practice uses, since wording and code boundaries are revised annually.

Keeping S72.461Q documentation in one place

The facts that decide this code are scattered across three documents. The wound grade lives in the emergency department note, the fracture pattern in the radiology report, and the malunion statement in a follow-up letter. Coders end up requesting records weeks after the visit, which is where subsequent encounter claims stall.

Practice management software like Pabau keeps clinical notes, imaging attachments, and coded diagnoses on one patient record. The supporting detail then travels with the encounter. Custom medical forms let orthopedic teams capture laterality, fracture pattern, and healing status as structured fields at the point of care rather than free text.

The outcome is a shorter path from visit to submitted claim. Your billing team sees what the clinician recorded, queries fewer notes, and sends cleaner claims the first time.

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Pabau helps orthopedic and MSK practices capture the documentation that supports precise ICD-10 coding at the point of care, reducing downstream denials and rework.

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Conclusion

The four elements behind S72.461Q are documentation problems before they are coding problems. Laterality, intracondylar extension and an open wound at Gustilo type I or II each sit in a different document. A physician-stated malunion sits in a fourth.

So the code rarely fails at submission. It fails at audit, when the record cannot produce one of the four. Pull those documents together while the patient is still in front of you, and the claim holds.

Pabau keeps that detail on the patient record, so the elements behind codes like S72.461Q are there when a payer asks. To see how Pabau handles ICD-10 documentation and claim workflows, book a demo.

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