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ICD-10 Guide
ICD-10 CodesS12.49

S12.49

Billable

Other fracture of fifth cervical vertebra

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

Code Description

ICD-10 S12.49 is a billable code used to indicate a diagnosis of other fracture of fifth cervical vertebra.

Key Diagnostic Point:

The S12.49 code refers to fractures of the fifth cervical vertebra (C5) that do not fall into the more specific categories of fractures. These injuries can occur due to various mechanisms, including trauma from motor vehicle accidents, falls, sports injuries, or violent acts. The cervical vertebrae are critical for supporting the skull and protecting the spinal cord, and fractures in this area can lead to significant neurological deficits, including paralysis or loss of sensation. Clinical evaluation typically involves a thorough history and physical examination, followed by imaging studies such as X-rays, CT scans, or MRIs to confirm the fracture and assess for 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 neurological deficits, making accurate diagnosis and management crucial.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and descriptions
  • Need for precise documentation of injury mechanism
  • Potential for associated neurological injuries
  • Differentiation from other cervical vertebra fractures

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the type of fracture
  • Misclassification of fracture severity
  • Lack of imaging documentation

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with acute neck pain following trauma, requiring imaging to rule out fractures.

Billing Considerations

Ensure that all relevant imaging studies are documented and that any neurological assessments are clearly noted.

Surgery

Documentation Requirements

Operative reports must detail the surgical approach, findings, and any complications encountered during the procedure.

Common Clinical Scenarios

Surgical intervention for unstable fractures or those with neurological compromise.

Billing Considerations

Document the rationale for surgical intervention and any preoperative assessments performed.

Coding Guidelines

Inclusion Criteria

Use S12.49 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code accurately reflects the specific type of fracture and its clinical implications
  • Documentation must support the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use S12.49 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

63015CPT Code

Laminectomy, cervical

Clinical Scenario

Performed for decompression of the spinal cord due to fracture.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Ensure that the procedure is linked to the diagnosis of cervical fracture.

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. S12.49 provides a distinct code for fractures that may not fit into more specific categories, enhancing clinical documentation.

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. S12.49 provides a distinct code for fractures that may not fit into more specific categories, enhancing clinical documentation.

Reimbursement & Billing Impact

reimbursement processes. S12.49 provides a distinct code for fractures that may not fit into more specific categories, enhancing clinical documentation.

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 S12.49 accurately?

Accurate coding of S12.49 is crucial for proper reimbursement, tracking of injury patterns, and ensuring appropriate management of patients with cervical fractures. It also aids in research and quality improvement initiatives.