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ICD-10 Guide
ICD-10 CodesS12.5

S12.5

Billable

Fracture of sixth cervical vertebra

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

Code Description

ICD-10 S12.5 is a billable code used to indicate a diagnosis of fracture of sixth cervical vertebra.

Key Diagnostic Point:

The S12.5 code refers to a fracture of the sixth cervical vertebra (C6), 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 significant heights, or sports-related injuries. The C6 vertebra is particularly vulnerable due to its location and the mobility of the cervical spine. Clinical presentation may include neck pain, neurological deficits, and limited range of motion. Diagnostic imaging, such as X-rays, CT scans, or MRIs, is essential for confirming the fracture and assessing any associated spinal cord injury. Management typically involves immobilization, pain management, and in some cases, surgical intervention to stabilize the spine and prevent further neurological damage. Complications can include chronic pain, neurological impairment, and instability of the cervical spine, necessitating careful monitoring and follow-up care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in injury mechanisms leading to different clinical presentations
  • Need for precise documentation of neurological status
  • Potential for associated injuries requiring additional coding
  • Variability in treatment approaches (conservative vs. surgical)

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document neurological assessments
  • Misclassification of fracture type or location
  • Omission of associated injuries in coding

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Complete documentation of initial assessment, including neurological status and imaging results.

Common Clinical Scenarios

Trauma patients presenting with neck pain after a fall or motor vehicle accident.

Billing Considerations

Ensure that all relevant details of the injury mechanism are captured to support coding.

Surgery

Documentation Requirements

Detailed operative reports including indications for surgery, surgical findings, and postoperative care.

Common Clinical Scenarios

Patients requiring surgical intervention for stabilization of the cervical spine.

Billing Considerations

Document any intraoperative findings that may affect coding, such as additional injuries.

Coding Guidelines

Inclusion Criteria

Use S12.5 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code reflects the specific site and type of fracture
  • Document the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use S12.5 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 C6 fracture stabilization.

Documentation Requirements

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

Specialty Considerations

Ensure that the surgical necessity is well-documented to support the procedure.

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. S12.5 provides a clear designation for C6 fractures, facilitating better tracking and management of these injuries.

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. S12.5 provides a clear designation for C6 fractures, facilitating better tracking and management of these injuries.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of cervical spine injuries, improving the granularity of data for treatment and outcomes. S12.5 provides a clear designation for C6 fractures, facilitating better tracking and management of these injuries.

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 are the common causes of a C6 fracture?

Common causes include high-impact trauma from motor vehicle accidents, falls, and sports injuries. The mechanism of injury often involves significant force applied to the cervical spine.

How is a C6 fracture diagnosed?

Diagnosis typically involves a combination of clinical evaluation, neurological assessment, and imaging studies such as X-rays, CT scans, or MRIs to confirm the fracture and assess for any spinal cord involvement.

What are the treatment options for a C6 fracture?

Treatment options vary based on the severity of the fracture and may include conservative management with immobilization and pain control, or surgical intervention for stabilization and decompression if there is spinal cord involvement.