S13.4XXA

S13.4XXA: Sprain of ligaments of cervical spine, initial encounter

Billable / specific codeICD-10-CM

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.

Check S13.4XXA with the rest of the claim: free scrubber

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

Not part of this code, but both may be coded when both are present.

Written on S13: Dislocation and sprain of joints and ligaments at neck level

strain of muscle or tendon at neck level (S16.1)

Risk adjustment

No CMS-HCC V28 category: this code does not change 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 one applies depends on your Medicare contractor.

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

Unchanged in every release from FY2024 to FY2027.