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ICD-10 Guide
ICD-10 CodesS12.6

S12.6

Billable

Fracture of seventh cervical vertebra

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

Code Description

ICD-10 S12.6 is a billable code used to indicate a diagnosis of fracture of seventh cervical vertebra.

Key Diagnostic Point:

The fracture of the seventh cervical vertebra (C7) is a significant injury that can result from various mechanisms, including trauma from falls, motor vehicle accidents, or sports injuries. The C7 vertebra is located at the base of the neck and is crucial for supporting the head and facilitating neck movement. Fractures in this area can lead to severe complications, including spinal cord injury, which may result in paralysis or loss of sensation below the level of the injury. Clinical presentation often includes neck pain, limited range of motion, and neurological deficits. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the fracture's extent and any associated spinal cord injury. Management may include conservative treatment with immobilization or surgical intervention, depending on the fracture's stability and the presence of neurological compromise. Complications can include chronic pain, instability, and long-term disability, making accurate coding essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types (e.g., stable vs. unstable)
  • Potential for associated neurological injuries
  • Need for precise documentation of mechanism of injury
  • Differentiation from other cervical vertebra fractures

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document neurological assessments
  • Misclassification of fracture type (e.g., stable vs. unstable)
  • Inconsistent coding of associated conditions

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

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

Common Clinical Scenarios

Trauma patients presenting with neck pain after falls or accidents.

Billing Considerations

Ensure thorough documentation of neurological status and mechanism of injury for accurate coding.

Surgery

Documentation Requirements

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

Common Clinical Scenarios

Patients requiring surgical intervention for unstable fractures or decompression of the spinal cord.

Billing Considerations

Document any complications or additional procedures performed during surgery.

Coding Guidelines

Inclusion Criteria

Use S12.6 When
  • Follow ICD
  • CM guidelines for coding fractures, ensuring specificity in the type of fracture and any associated conditions
  • Document the mechanism of injury and any neurological assessments

Exclusion Criteria

Do NOT use S12.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Anterior cervical discectomy and fusion

Clinical Scenario

Used for surgical management of C7 fractures with spinal cord compression.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Ensure alignment with the diagnosis of C7 fracture.

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 differentiate between closed and open fractures, which is crucial for treatment and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including the ability to differentiate between closed and open fractures, which is crucial for treatment 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 is the difference between closed and open fractures of the C7 vertebra?

Closed fractures do not break the skin, while open fractures involve a break in the skin and expose the bone. This distinction is crucial for coding and treatment planning.