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ICD-10 Guide
ICD-10 CodesS12.20

S12.20

Billable

Unspecified fracture of third cervical vertebra

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

Code Description

ICD-10 S12.20 is a billable code used to indicate a diagnosis of unspecified fracture of third cervical vertebra.

Key Diagnostic Point:

The S12.20 code represents an unspecified fracture of the third cervical vertebra (C3), which is a critical component of the cervical spine. Fractures in this region can occur due to various mechanisms, including trauma from motor vehicle accidents, falls, sports injuries, or violent acts. The cervical spine is responsible for supporting the head and protecting the spinal cord, making injuries in this area potentially serious. Symptoms may include neck pain, limited range of motion, neurological deficits, or even paralysis, depending on the severity and type of fracture. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the extent of the injury. Management may range from conservative treatment, including immobilization and physical therapy, to surgical intervention in cases of instability or neurological compromise. Accurate coding is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and severity
  • Need for precise documentation of mechanism of injury
  • Differentiation from other cervical spine injuries
  • Potential for associated neurological complications

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the type of fracture
  • Lack of imaging results in the medical record
  • Inconsistent coding with clinical findings

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Documentation must include a detailed account of the injury mechanism, initial assessment findings, and any imaging performed.

Common Clinical Scenarios

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

Billing Considerations

Ensure that all neurological assessments are documented, as they are critical for determining the severity of the injury.

Surgery

Documentation Requirements

Operative reports must detail the surgical approach, findings, and any fixation devices used.

Common Clinical Scenarios

Surgical intervention for unstable fractures or those causing spinal cord compression.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use S12.20 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the fracture type is unspecified and that all relevant clinical information is documented

Exclusion Criteria

Do NOT use S12.20 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 C3 fractures.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Ensure that the surgical approach aligns with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, improving the granularity of data collected and enhancing the ability to track outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the granularity of data collected and enhancing the ability to track outcomes and resource utilization.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, improving the granularity of data collected and enhancing the ability to track outcomes and resource utilization.

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 should I document to support the use of S12.20?

Document the mechanism of injury, imaging results, neurological assessments, and treatment provided to ensure accurate coding.