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ICD-10 Guide
ICD-10 CodesS12.00

S12.00

Billable

Unspecified fracture of first cervical vertebra

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

Code Description

ICD-10 S12.00 is a billable code used to indicate a diagnosis of unspecified fracture of first cervical vertebra.

Key Diagnostic Point:

The S12.00 code refers to an unspecified fracture of the first cervical vertebra, commonly known as the atlas. This type of fracture can occur due to high-impact trauma, such as motor vehicle accidents, falls from significant heights, or sports injuries. The atlas is crucial for supporting the skull and facilitating head movement, making injuries to this vertebra particularly concerning due to the potential for spinal cord injury and neurological deficits. Clinical presentation may include neck pain, limited range of motion, and neurological symptoms such as weakness or numbness in the extremities. Diagnosis typically involves imaging studies, including X-rays, CT scans, or MRIs, to confirm the fracture and assess for associated injuries. Management may range from conservative treatment, such as immobilization with a cervical collar, to surgical intervention in cases of instability or neurological compromise. Complications can include chronic pain, neurological deficits, or instability of the cervical spine if not properly managed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of injury
  • Need for precise documentation of mechanism of injury
  • Potential for associated injuries requiring additional coding
  • Differentiation from other cervical vertebra fractures

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify associated injuries or complications
  • Misclassification of fracture type or location
  • Inconsistent coding across different healthcare providers

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with trauma from falls, MVCs, or sports injuries requiring immediate evaluation.

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 methods used.

Common Clinical Scenarios

Surgical management of unstable fractures or decompression of the spinal cord.

Billing Considerations

Accurate coding of surgical procedures must align with the diagnosis of the fracture.

Coding Guidelines

Inclusion Criteria

Use S12.00 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code reflects the specific nature of the injury and any associated conditions
  • Documentation must support the diagnosis and any additional codes used

Exclusion Criteria

Do NOT use S12.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Anterior cervical discectomy and fusion

Clinical Scenario

Used in cases of instability or neurological compromise due to cervical fractures.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Ensure alignment with diagnosis and any pre-operative imaging findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of cervical fractures, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of cervical fractures, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 significance of coding S12.00 accurately?

Accurate coding of S12.00 is crucial for proper reimbursement, tracking of injury patterns, and ensuring appropriate patient management. It also helps in identifying trends in cervical spine injuries for public health data.