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S12.040A vs S12.040D

S12.040A (Displaced lateral mass fracture of first cervical vertebra, initial encounter for closed fracture) compared with S12.040D (Displaced lateral mass fracture of first cervical vertebra, subsequent encounter for fracture with routine healing), from the official CMS tabular data. S12.040A and S12.040D code the same injury at a different phase of treatment.

Relationship

Review

Encounter relationship

S12.040A
Initial encounter
Displaced lateral mass fracture of first cervical vertebra, initial encounter for closed fracture
↔
S12.040D
Subsequent encounter
Displaced lateral mass fracture of first cervical vertebra, subsequent encounter for fracture with routine healing

Same underlying diagnosis, different encounter phase.

The 7th character records the phase of care for the encounter being coded, so a single encounter takes one of these characters, not several. Review whether both phases belong on the same episode of care.

Source: ICD-10-CM Official Guidelines, Section I.C.19.a

Can these codes be reported together?

Same injury, other encounter phase. S12.040A and S12.040D code the same injury at a different phase of treatment, set by the 7th character.

The 7th character records the type of care given at the encounter being coded (ICD-10-CM Official Guidelines, Section I.C.19.a), so one encounter takes one of these, not both.

Side by side

S12.040ADisplaced lateral mass fracture of first cervical vertebra, initial encounter for closed fractureS12.040DDisplaced lateral mass fracture of first cervical vertebra, subsequent encounter for fracture with routine healing
Billing statusBillableBillable
ClassificationS00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)
DefinitionDisplaced lateral mass fracture of first cervical vertebra, initial encounter for closed fracture is a billable ICD-10-CM diagnosis code (S12.040A).Displaced lateral mass fracture of first cervical vertebra, subsequent encounter for fracture with routine healing is a billable ICD-10-CM diagnosis code (S12.040D).
7th characterThe appropriate 7th character is to be added to all codes from subcategories S12.0-S12.6The appropriate 7th character is to be added to all codes from subcategories S12.0-S12.6
Includes
fracture of cervical neural arch
fracture of cervical spine
fracture of cervical spinous process
fracture of cervical transverse process
fracture of cervical neural arch
fracture of cervical spine
fracture of cervical spinous process
fracture of cervical transverse process
Code first
any associated cervical spinal cord injury (S14.0, S14.1-)
any associated cervical spinal cord injury (S14.0, S14.1-)
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Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources