S12.01XA: Stable burst fracture of first cervical vertebra, initial encounter for closed fracture
S12.01XA is a billable, specific ICD-10-CM code for stable burst fracture of first cervical vertebra, initial encounter for closed fracture. It is valid for submission on a claim.
Check S12.01XA with the rest of the claim: free scrubber7th character "A": initial encounter for closed fracture
The appropriate 7th character is to be added to all codes from subcategories S12.0-S12.6
- A
- initial encounter for closed fracture
- B
- initial encounter for open fracture
- D
- subsequent encounter for fracture with routine healing
- G
- subsequent encounter for fracture with delayed healing
- K
- subsequent encounter for fracture with nonunion
- S
- sequela
Other codes that can never be billed with S12.01XA
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
S12.01XA risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 401 Vertebral Fractures without Spinal Cord Injury0.522 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
S12.01XA is named in 8 Medicare coverage policies: 8 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A57132Billing and Coding: Bone Mass Measurement
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
- A57205Billing and Coding: Oximetry Services
- A57311Billing and Coding: Physical Therapy - Home Health
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S12.01
- S12.01XBStable burst fracture of first cervical vertebra, initial encounter for open fracture
- S12.01XDStable burst fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
- S12.01XGStable burst fracture of first cervical vertebra, subsequent encounter for fracture with delayed healing
- S12.01XKStable burst fracture of first cervical vertebra, subsequent encounter for fracture with nonunion
- S12.01XSStable burst fracture of first cervical vertebra, sequela