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ICD-10 Guide
ICD-10 CodesS12.401

S12.401

Billable

Unspecified nondisplaced fracture of fifth cervical vertebra

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

Code Description

ICD-10 S12.401 is a billable code used to indicate a diagnosis of unspecified nondisplaced fracture of fifth cervical vertebra.

Key Diagnostic Point:

The S12.401 code refers to an unspecified nondisplaced fracture of the fifth cervical vertebra (C5). This type of injury typically occurs due to trauma, such as falls, motor vehicle accidents, or sports injuries. A nondisplaced fracture means that the bone has cracked but has not moved out of its normal alignment. Clinically, patients may present with neck pain, limited range of motion, and neurological symptoms depending on the severity of the injury and any associated spinal cord involvement. Diagnosis is usually confirmed through imaging studies, such as X-rays or MRI, which help visualize the fracture and assess for any potential complications. Management may include conservative treatment with immobilization, pain management, and physical therapy, or surgical intervention if there is significant instability or neurological compromise. Complications can include chronic pain, reduced mobility, or, in severe cases, spinal cord injury leading to paralysis. Accurate coding is essential for proper treatment reimbursement and tracking of injury patterns.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Need for precise documentation of injury mechanism
  • 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 (nondisplaced vs. displaced)
  • Lack of imaging results in the medical record
  • Inconsistent clinical findings reported

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 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 with neurological deficits.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use S12.401 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code reflects the specific nature of the fracture and any associated conditions
  • Documentation must support the diagnosis and treatment provided

Exclusion Criteria

Do NOT use S12.401 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 stabilization.

Documentation Requirements

Operative report must detail the procedure and rationale.

Specialty Considerations

Orthopedic and neurosurgical documentation must align 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 cervical spine injuries, improving the granularity of data for treatment and outcomes. S12.401 provides a clear designation for nondisplaced fractures, aiding in clinical decision-making 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 granularity of data for treatment and outcomes. S12.401 provides a clear designation for nondisplaced fractures, aiding in clinical decision-making 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 difference between a displaced and nondisplaced fracture?

A displaced fracture means the bone fragments have moved out of alignment, while a nondisplaced fracture indicates that the bone remains in its normal position despite the fracture.