ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the ED physician treated a patient with severe neck pain. Final diagnosis was a fracture of the first cervical vertebra. How should I report this encounter?

New Jersey Subscriber

Answer: You’ll start at S12.0- (Fracture of cervical vertebra and other parts of neck) — but that’s not where you’ll finish.

Go back and check the notes for the following information on the patient’s injury:

• What type of fracture did the surgeon treat? Open, closed, displaced, nondisplaced, stable burst, unstable burst. etc.
• What treatment stage was the encounter for? Initial, subsequent, sequala, etc.

Then, you’ll choose one of the following codes, depending on the answers to the questions above:

• S12.000- (Unspecified displaced fracture of first cervical vertebra)
• S12.001- (Unspecified nondisplaced fracture of first cervical vertebra)
• S12.01X- (Stable burst fracture of first cervical vertebra)
• S12.02X- (Unstable burst fracture of first cervical vertebra)
• S12.030- (Displaced posterior arch fracture of first cervical vertebra)
• S12.031- (Nondisplaced posterior arch fracture of first cervical vertebra)
• S12.040- (Displaced lateral mass fracture of first cervical vertebra)
• S12.041- (Nondisplaced lateral mass fracture of first cervical vertebra)
• S12.090- (Other displaced fracture of first cervical vertebra)
• S12.091- (Other nondisplaced fracture of first cervical vertebra)

1 more thing: No matter your ultimate code choice, report A (initial encounter for closed fracture) as the 7th character to complete the diagnosis.