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ICD-10 Guide
ICD-10 CodesS12.12

S12.12

Billable

Other dens fracture

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

Code Description

ICD-10 S12.12 is a billable code used to indicate a diagnosis of other dens fracture.

Key Diagnostic Point:

A dens fracture, also known as an odontoid fracture, involves a break in the dens, which is the bony projection of the second cervical vertebra (C2). This type of fracture is often the result of high-energy trauma, such as motor vehicle accidents or falls, particularly in older adults. The dens is crucial for the stability and movement of the cervical spine, and fractures can lead to significant complications, including spinal cord injury and instability. Clinical presentation may include neck pain, limited range of motion, and neurological deficits depending on the severity of the injury. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the fracture's location and displacement. Management may range from conservative treatment with immobilization to surgical intervention, depending on the fracture's stability and associated injuries. Complications can include nonunion, malunion, and neurological deficits, making prompt and accurate diagnosis and treatment essential.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and associated injuries
  • Need for precise imaging interpretation
  • Potential for neurological involvement
  • Differentiation from other cervical spine injuries

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the type of dens fracture
  • Misinterpretation of imaging results
  • Inconsistent coding of associated injuries

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Complete documentation of the patient's presentation, mechanism of injury, and initial assessment findings.

Common Clinical Scenarios

Trauma patients presenting with neck pain after a fall or motor vehicle accident.

Billing Considerations

Ensure that all imaging results and neurological assessments are documented to support the diagnosis.

Surgery

Documentation Requirements

Detailed operative reports including the type of fracture, surgical approach, and any hardware used.

Common Clinical Scenarios

Patients requiring surgical stabilization of a dens fracture due to instability.

Billing Considerations

Document any pre-existing conditions that may affect surgical outcomes.

Coding Guidelines

Inclusion Criteria

Use S12.12 When
  • Follow the official ICD
  • CM coding guidelines, ensuring specificity in the documentation of the fracture type and associated injuries
  • Use additional codes for any complications or related conditions

Exclusion Criteria

Do NOT use S12.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Cervical spine fusion

Clinical Scenario

Used in cases where surgical stabilization of a dens fracture is required.

Documentation Requirements

Operative report detailing the procedure and indications for surgery.

Specialty Considerations

Ensure that the surgical approach and any hardware used 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 dens fractures, which enhances the accuracy of patient records and facilitates better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including dens fractures, which enhances the accuracy of patient records and facilitates better treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding fractures, including dens fractures, which enhances the accuracy of patient records and facilitates better treatment planning.

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 is the difference between S12.12 and S12.11?

S12.12 specifies 'Other dens fracture,' indicating a specific type of fracture, while S12.11 is used when the type of dens fracture is unspecified.