S12.101B: Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for open fracture
S12.101B is a billable, specific ICD-10-CM code for unspecified nondisplaced fracture of second cervical vertebra, initial encounter for open fracture. It is valid for submission on a claim.
Check S12.101B with the rest of the claim: free scrubber7th 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
Other codes that can never be billed with S12.101B
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
S12.101B 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
S12.101B is named in 17 Medicare coverage policies: 17 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
- 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.
Other codes under S12.101
- S12.101AUnspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture
- S12.101DUnspecified nondisplaced fracture of second cervical vertebra, subsequent encounter for fracture with routine healing
- S12.101GUnspecified nondisplaced fracture of second cervical vertebra, subsequent encounter for fracture with delayed healing
- S12.101KUnspecified nondisplaced fracture of second cervical vertebra, subsequent encounter for fracture with nonunion
- S12.101SUnspecified nondisplaced fracture of second cervical vertebra, sequela