S12.101A

S12.101A: Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture

Billable / specific codeICD-10-CM

S12.101A is a billable, specific ICD-10-CM code for unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture. It is valid for submission on a claim.

Check S12.101A with the rest of the claim: free scrubber

7th 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 S12.101A

Their own Excludes1 notes name this code, so the conflict is not listed above.

M48.5Collapsed vertebra, not elsewhere classified
M84.3Stress fracture
M84.4Pathological fracture, not elsewhere classified

Risk adjustment

S12.101A 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

S12.101A is named in 13 Medicare coverage policies: 13 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56619Billing and Coding: Nerve Conduction Studies and Electromyography
A56722Billing and Coding: Intraoperative Neurophysiological Testing
A56773Billing and Coding: Neurophysiology Evoked Potentials (NEPs)
A56802Billing and Coding: Urodynamics

Code history

Unchanged in every release from FY2024 to FY2027.