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ICD-10 Guide
ICD-10 CodesS12.3

S12.3

Billable

Fracture of fourth cervical vertebra

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

Code Description

ICD-10 S12.3 is a billable code used to indicate a diagnosis of fracture of fourth cervical vertebra.

Key Diagnostic Point:

The S12.3 code refers to a fracture of the fourth cervical vertebra (C4), which is a critical component of the cervical spine. This type of fracture can occur due to various mechanisms of injury, including high-impact trauma such as motor vehicle accidents, falls from heights, or sports injuries. The C4 vertebra is located in the neck region and plays a vital role in supporting the skull and protecting the spinal cord. Fractures at this level can lead to significant neurological deficits, including quadriplegia, depending on the severity and type of fracture. Clinical evaluation typically involves a thorough history and physical examination, followed by imaging studies such as X-rays, CT scans, or MRIs to assess the extent of the injury. Management may include conservative treatment with immobilization or surgical intervention, such as decompression and stabilization, depending on the fracture's characteristics and associated neurological compromise. Complications can include chronic pain, instability, and potential for further neurological impairment if not managed appropriately.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types (e.g., compression, burst, or dislocation)
  • Potential for associated neurological injuries
  • Need for precise documentation of mechanism of injury
  • Variations in treatment approaches (surgical vs. conservative)

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the type of fracture
  • Lack of imaging report details
  • Inconsistent coding of associated neurological deficits

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

Trauma patients presenting after motor vehicle accidents or falls, requiring immediate evaluation and stabilization.

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 hardware used for stabilization.

Common Clinical Scenarios

Patients undergoing surgical intervention for C4 fractures, including decompression and fusion procedures.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use S12.3 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code reflects the specific type of fracture and any associated conditions
  • Document the mechanism of injury and any neurological deficits

Exclusion Criteria

Do NOT use S12.3 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 necessary for C4 fractures with neurological compromise.

Documentation Requirements

Operative report detailing the procedure, indications, and any complications.

Specialty Considerations

Ensure that the surgical approach aligns with the diagnosis for accurate billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of cervical spine injuries, 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 spine injuries, 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 S12.3 accurately?

Accurate coding of S12.3 is crucial for appropriate reimbursement, tracking of injury patterns, and ensuring that patients receive the correct level of care based on the severity of their injuries.