ICD-10 Coding for Cervical Fracture(S12.000A, S12.400A)
Complete ICD-10-CM coding and documentation guide for Cervical Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Cervical Fracture
S12.0-S12.9Primary Range
Fracture of cervical vertebra
This range covers all fractures of the cervical vertebrae, including specific vertebrae from C1 to C7.
Injury of nerves and spinal cord at neck level
These codes are used for associated spinal cord injuries that occur with cervical fractures.
Osteoporosis with pathological fracture, cervical region
Used when a cervical fracture is due to osteoporosis or other pathological conditions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S12.000A | Fracture of first cervical vertebra, initial encounter for closed fracture | Use for initial encounters of closed fractures of the first cervical vertebra. |
|
| S12.400A | Displaced fracture of fifth cervical vertebra, initial encounter for closed fracture | Use for initial encounters of displaced fractures of the fifth cervical vertebra. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for cervical fracture
Essential facts and insights about Cervical Fracture
Primary ICD-10-CM Codes for cervical fracture
Decision Criteria
clinical Criteria
- Radiological evidence of C1 fracture
documentation Criteria
- Documentation of closed fracture
Applicable To
- C1 burst fracture
Excludes
- Injury of nerves and spinal cord at neck level (S14.-)
Clinical Validation Requirements
- Radiological confirmation of C1 fracture
- Clinical documentation specifying closed fracture
Code-Specific Risks
- Misclassification if fracture type is not specified
Coding Notes
- Ensure the fracture type (e.g., burst, compression) is documented.
S12.400A - Displaced fracture of fifth cervical vertebra, initial encounter for closed fracture
Use for initial encounters of displaced fractures of the fifth cervical vertebra.
Applicable To
- C5 teardrop fracture
Excludes
- Injury of nerves and spinal cord at neck level (S14.-)
Clinical Validation Requirements
- Radiological confirmation of C5 fracture
- Clinical documentation specifying displaced fracture
Coding Notes
Ensure the displacement status is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Cervical Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S12.000A.
Impact
Clinical: Lack of specificity in patient records., Regulatory: Potential for audit issues., Financial: May lead to denied claims.
Mitigation Strategy
Always specify the vertebra and fracture type, Use detailed imaging reports
Impact
Reimbursement: Incorrect DRG assignment leading to payment errors., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Query the provider for specific vertebra level if not documented.
Impact
Reimbursement: Potential underpayment due to missing MCC codes., Compliance: Failure to capture complete clinical picture., Data Quality: Incomplete patient records.
Mitigation Strategy
Ensure neurological deficits are documented and coded with S14 codes.
Impact
Failure to document all aspects of the fracture and associated injuries.
Mitigation Strategy
Implement thorough documentation protocols and regular audits.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Cervical Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Cervical Fracture
Use these documentation templates to ensure complete and accurate documentation for Cervical Fracture. These templates include all required elements for proper coding and billing.
Emergency Department Evaluation
Specialty: Emergency MedicineRequired Elements
- Patient history
- Imaging results
- Fracture type and vertebra level
- Neurological assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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