S12.500G

S12.500G: Unspecified displaced fracture of sixth cervical vertebra, subsequent encounter for fracture with delayed healing

Billable / specific codeICD-10-CMPOA exempt

S12.500G is a billable, specific ICD-10-CM code for unspecified displaced fracture of sixth cervical vertebra, subsequent encounter for fracture with delayed healing. It is valid for submission on a claim.

Check S12.500G with the rest of the claim: free scrubber

7th character "G": subsequent encounter for fracture with delayed healing

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 S12.500G

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

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

S12.500G is named in 10 Medicare coverage policies: 10 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A53058Billing and Coding: Home Health Physical Therapy
A53065Billing and Coding: Outpatient Physical Therapy
A57311Billing and Coding: Physical Therapy - Home Health
A59608Billing and Coding: Cervical Fusion

Code history

Unchanged in every release from FY2024 to FY2027.