S12.01XB — Stable burst fracture of first cervical vertebra, initial encounter for open fracture
S12.01XB is a billable, specific ICD-10-CM code for stable burst fracture of first cervical vertebra, initial encounter for open fracture. It is valid for submission on a claim.
7th character "B" — initial encounter for open 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
Risk adjustment
S12.01XB 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.
Medicare coverage
S12.01XB is named in 18 Medicare coverage policies — 18 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
- A56900Billing and Coding: Immunizations
- A57132Billing and Coding: Bone Mass Measurement
- A57132Billing and Coding: Bone Mass Measurement
Related codes at this level
Codes that share S12.01. If S12.01XB is not quite right, the correct code is usually one of these.
- S12.01XAStable burst fracture of first cervical vertebra, initial encounter for closed 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
Questions about S12.01XB
- Is S12.01XB a billable ICD-10-CM code?
- Yes. S12.01XB is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S12.01XB sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the neck (S10-S19).