S12.031B — Nondisplaced posterior arch fracture of first cervical vertebra, initial encounter for open fracture
S12.031B is a billable, specific ICD-10-CM code for nondisplaced posterior arch 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
S12.031B 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
S12.031B is named in 17 Medicare coverage policies — 17 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56900Billing and Coding: Immunizations
- A57132Billing and Coding: Bone Mass Measurement
- A57132Billing and Coding: Bone Mass Measurement
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
Related codes at this level
Codes that share S12.031. If S12.031B is not quite right, the correct code is usually one of these.
- S12.031ANondisplaced posterior arch fracture of first cervical vertebra, initial encounter for closed fracture
- S12.031DNondisplaced posterior arch fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
- S12.031GNondisplaced posterior arch fracture of first cervical vertebra, subsequent encounter for fracture with delayed healing
- S12.031KNondisplaced posterior arch fracture of first cervical vertebra, subsequent encounter for fracture with nonunion
- S12.031SNondisplaced posterior arch fracture of first cervical vertebra, sequela
Questions about S12.031B
- Is S12.031B a billable ICD-10-CM code?
- Yes. S12.031B is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S12.031B 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).