S12.01XS
S12.01XS — Stable burst fracture of first cervical vertebra, sequela
Billable / specific codeICD-10-CMPOA exempt
S12.01XS is a billable, specific ICD-10-CM code for stable burst fracture of first cervical vertebra, sequela. It is valid for submission on a claim.
7th character "S" — sequela
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
S12.01XS does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
S12.01XS is named in 13 Medicare coverage policies — 13 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
Related codes at this level
Codes that share S12.01. If S12.01XS 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
- S12.01XBStable 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
Questions about S12.01XS
- Is S12.01XS a billable ICD-10-CM code?
- Yes. S12.01XS is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S12.01XS 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).