S13.4XXA — Sprain of ligaments of cervical spine, initial encounter
S13.4XXA is a billable, specific ICD-10-CM code for sprain of ligaments of cervical spine, initial encounter. It is valid for submission on a claim.
7th character "A" — initial encounter
The appropriate 7th character is to be added to each code from category S13
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Sprain of anterior longitudinal (ligament), cervical
- Sprain of atlanto-axial (joints)
- Sprain of atlanto-occipital (joints)
- Whiplash injury of cervical spine
Risk adjustment
S13.4XXA does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
S13.4XXA is named in 11 Medicare coverage policies — 6 listing it as supporting medical necessity, and 5 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57701Billing and Coding: Trigger Point Injections (TPI)not covered
- A59480Billing and Coding: Trigger Point Injections (TPI)not covered
- A59487Billing and Coding: Trigger Point Injections (TPI)not covered
- A59498Billing and Coding: Trigger Point Injections (TPI)not covered
Related codes at this level
Codes that share S13.4. If S13.4XXA is not quite right, the correct code is usually one of these.
Questions about S13.4XXA
- Is S13.4XXA a billable ICD-10-CM code?
- Yes. S13.4XXA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S13.4XXA sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the neck (S10-S19).