S12.040S
S12.040S: Displaced lateral mass fracture of first cervical vertebra, sequela
Billable / specific codeICD-10-CMPOA exempt
S12.040S is a billable, specific ICD-10-CM code for displaced lateral mass fracture of first cervical vertebra, sequela. It is valid for submission on a claim.
Check S12.040S with the rest of the claim: free scrubber7th 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
Other codes that can never be billed with S12.040S
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
S12.040S is named in 13 Medicare coverage policies: 13 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- 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
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S12.040
- S12.040ADisplaced lateral mass fracture of first cervical vertebra, initial encounter for closed fracture
- S12.040BDisplaced lateral mass fracture of first cervical vertebra, initial encounter for open fracture
- S12.040DDisplaced lateral mass fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
- S12.040GDisplaced lateral mass fracture of first cervical vertebra, subsequent encounter for fracture with delayed healing
- S12.040KDisplaced lateral mass fracture of first cervical vertebra, subsequent encounter for fracture with nonunion