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
Excludes2 inherited from the categories above S13.4XXA
Also inherited, and the opposite of Excludes1: these conditions are not part of S13.4XXA, but a patient can have both, so you may code both.
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
Code history
S13.4XXA has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
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).