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S72.009C ICD-10-CM Code: Fracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC

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FY 2026 Apr update / Injury, poisoning and certain other consequences of external causes (S00-T88) / Injuries to the hip and thigh (S70-S79)

S72.009C

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Fracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC

Fracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC

CMS-HCC V28

HCC 402

RAF 0.467

CMS-HCC V24

HCC 170

RAF 0.350

ACA/HHS

0

0

RAF 0

ESRD/PACE

HCC 170

RAF 0.0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
S72.00Fracture of unspecified part of neck of femur
S72.009Fracture of unspecified part of neck of unspecified femur
S72.009CFracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for S72.009C in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for S72.009C in this effective period.

Related Child Codes

Official
S72.009AFracture of unspecified part of neck of unspecified femur, initial encounter for closed fracture
S72.009BFracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type I or II
S72.009DFracture of unspecified part of neck of unspecified femur, subsequent encounter for closed fracture with routine healing
S72.009EFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type I or II with routine healing
S72.009FFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

Includes

Official

ICD-10-CM does not list Includes notes for S72.009C in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for S72.009C in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for S72.009C in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for S72.009C in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for S72.009C in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is S72.009C an HCC code?

Yes. S72.009C maps to Hip Fracture/Dislocation under the CMS-HCC V28 risk adjustment model (and Hip Fracture/Dislocation under V24).

HCC Category Mapping

V28HCC 402, Hip Fracture/Dislocation
0.467
V24HCC 170, Hip Fracture/Dislocation
0.350
ESRDHCC 170, Hip Fracture/Dislocation
0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

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MEAT Criteria for S72.009C

For S72.009Cto count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

  • MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
  • EEvaluate: test results, medication response, or physical findings reviewed by the provider
  • AAssess: explicit mention in the assessment or plan with acknowledgment of status
  • TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed S72.009C during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

S72.009C is the ICD-10-CM diagnosis code for fracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type iiia, iiib, or iiic. S72.009C sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering injuries to the hip and thigh (s70-s79).

Under the CMS-HCC V28 risk adjustment model, S72.009C maps to Hip Fracture/Dislocation (HCC 402) with a community, non-dual, aged base RAF weight of 0.467. Under the older V24 model, S72.009C mapped to the same category but with a base RAF weight of 0.350, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Coders should report S72.009C only when the provider documentation supports the specific condition described, since more specific codes within the same hierarchy can capture additional clinical detail and may carry a higher RAF weight. Because S72.009C maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for S72.009C sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

S72.009AFracture of unspecified part of neck of unspecified femur, initial encounter for closed fracture
HCC 402
S72.009BFracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type I or II
HCC 402
S72.009CFracture of unspecified part of neck of unspecified femur, initial encounter for open fracture type IIIA, IIIB, or IIIC
HCC 402
S72.009DFracture of unspecified part of neck of unspecified femur, subsequent encounter for closed fracture with routine healing
S72.009EFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type I or II with routine healing
S72.009FFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
S72.009GFracture of unspecified part of neck of unspecified femur, subsequent encounter for closed fracture with delayed healing
S72.009HFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type I or II with delayed healing
S72.009JFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
S72.009KFracture of unspecified part of neck of unspecified femur, subsequent encounter for closed fracture with nonunion
S72.009MFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type I or II with nonunion
S72.009NFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
S72.009PFracture of unspecified part of neck of unspecified femur, subsequent encounter for closed fracture with malunion
S72.009QFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type I or II with malunion
S72.009RFracture of unspecified part of neck of unspecified femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S72.009SFracture of unspecified part of neck of unspecified femur, sequela

Code Hierarchy

Because S72.009C maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

S72.009C maps to CMS-HCC V28 category 402, Hip Fracture/Dislocation. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works.

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