S12.121B

S12.121B: Other nondisplaced dens fracture, initial encounter for open fracture

Billable / specific codeICD-10-CM

S12.121B is a billable, specific ICD-10-CM code for other nondisplaced dens fracture, initial encounter for open fracture. It is valid for submission on a claim.

Check S12.121B with the rest of the claim: free scrubber

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

Other codes that can never be billed with S12.121B

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

S12.121B 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

S12.121B is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
A56900Billing and Coding: Immunizations
A57132Billing and Coding: Bone Mass Measurement
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

Code history

Unchanged in every release from FY2024 to FY2027.