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ICD-10 Guide
ICD-10 CodesS12.0

S12.0

Billable

Fracture of first cervical vertebra

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 S12.0 is a billable code used to indicate a diagnosis of fracture of first cervical vertebra.

Key Diagnostic Point:

The fracture of the first cervical vertebra, also known as the atlas, is a critical injury that can result from high-impact trauma, such as motor vehicle accidents, falls from heights, or sports injuries. This vertebra supports the skull and allows for the nodding motion of the head. Due to its anatomical location and function, fractures in this area can lead to significant neurological deficits, including spinal cord injury, which may result in paralysis or other serious complications. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the extent of the fracture and any associated injuries. Management may include immobilization with a cervical collar, surgical intervention for stabilization, and rehabilitation to restore function. Given the potential for severe outcomes, prompt recognition and treatment are essential.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Potential for associated neurological injuries
  • Variability in presentation and severity of fractures
  • Need for precise imaging interpretation
  • Surgical versus non-surgical management decisions

Audit Risk Factors

  • Inadequate documentation of mechanism of injury
  • Failure to specify if neurological deficits are present
  • Misclassification of fracture type (e.g., stable vs. unstable)
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Complete documentation of initial assessment, imaging results, and treatment plan.

Common Clinical Scenarios

Trauma patients presenting with neck pain after a fall or collision.

Billing Considerations

Ensure thorough documentation of neurological status and mechanism of injury.

Surgery

Documentation Requirements

Detailed operative notes, including indications for surgery and post-operative care.

Common Clinical Scenarios

Patients requiring surgical stabilization due to unstable fractures.

Billing Considerations

Document any intraoperative findings that may affect coding.

Coding Guidelines

Inclusion Criteria

Use S12.0 When
  • Follow ICD
  • CM guidelines for coding fractures, including specificity regarding the type of fracture and any associated injuries
  • Ensure to document the mechanism of injury and any neurological involvement

Exclusion Criteria

Do NOT use S12.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Anterior cervical discectomy and fusion

Clinical Scenario

Used in cases where surgical intervention is required for stabilization.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Ensure that the surgical approach and any complications are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, including the ability to capture details about the location and severity of cervical vertebra fractures, which is crucial for appropriate management and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including the ability to capture details about the location and severity of cervical vertebra fractures, which is crucial for appropriate management and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of S12.0 fractures?

Common causes include high-impact trauma such as motor vehicle accidents, falls, and sports injuries.

How is an S12.0 fracture diagnosed?

Diagnosis typically involves imaging studies like X-rays or CT scans to assess the fracture and any potential spinal cord involvement.

What are the potential complications of an S12.0 fracture?

Complications can include neurological deficits, chronic pain, and instability of the cervical spine.