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S12.09 ICD-10-CM Code: Other fracture of first cervical vertebra

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
9 inclusion terms · 7 Excludes2 · 1 code-first instruction

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for S12.09 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on S12.09 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • fracture of cervical neural arch inherited from S12
  • fracture of cervical spine inherited from S12
  • fracture of cervical spinous process inherited from S12
  • fracture of cervical transverse process inherited from S12
  • fracture of cervical vertebral arch inherited from S12
  • fracture of neck inherited from S12
  • injuries of nape inherited from S10-S19
  • injuries of supraclavicular region inherited from S10-S19
  • injuries of throat inherited from S10-S19

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from S10-S19

Code First

Underlying conditions that must be sequenced before this code.

  • any associated cervical spinal cord injury (S14.0, S14.1-)

Source: inherited from S12

7th Character Guide

"The appropriate 7th character is to be added to all codes from subcategories S12.0-S12.6"

  • A — initial encounter for closed fracture
  • B — initial encounter for open fracture
  • D — subsequent encounter for fracture with routine healing
  • G — subsequent encounter for fracture with delayed healing
  • K — subsequent encounter for fracture with nonunion
  • S — sequela

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

S12.090A, S12.090B, S12.090D, S12.090G, S12.090K, S12.090S, S12.091A, S12.091B

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for S12.09

MedCoder structured workflow — derived from this code’s own official record

Before you code S12.09

  1. S12.09 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewS12.090, S12.091

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on S12.09; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewS12.04

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  3. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. S12.09 is not valid without one. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

    See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

  4. Confirm the injury type, the anatomical site at the most specific level documented, laterality where the family codes it, and the encounter for the 7th character. Each injury is coded separately unless the classification provides a combination code, and a superficial injury is not coded when a more severe injury of the same site is documented. A fracture not documented as open or closed is coded as closed; one not documented as displaced or nondisplaced is coded as displaced. Injury chapter guidelines (Guidelines I.C.19.b, I.C.19.b.1, I.C.19.c).

    Guide: Traumatic vs pathological vs stress fracture →

Choose the right path

  1. Does the documentation support one of the more specific codes beneath S12.09?
    Yes → Select that code and continue the checks below on its own page.
    No → S12.09 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewS12.090, S12.091

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then S12.09.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewS14.0, S14.1

  3. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider S12.09. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Anatomical site
At the most specific level the record states; a site the classification separates cannot be assumed from a procedure or a measurement.
Encounter type
Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).
Open or closed; displaced or nondisplaced
Defaults apply when the record is silent: closed, and displaced (Guidelines I.C.19.c).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).
External cause, place and activity
For the external cause codes reported with the injury or poisoning, where documented (Guidelines I.C.20.a).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of S12.09(7 notes)

    Coding workflow: The conditions named in this note are not included in S12.09. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareT18.1, T17.3, T17.2, T17.4, T63.4

    See the official tabular notes · Guidelines I.A.12.b

  • Code First — sequencing check(1 note)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before S12.09. Do not add an underlying condition the record does not document.

    ReviewS14.0, S14.1

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The patient returns during the healing or recovery phase after active treatment of the same condition.

Coding question: Which 7th character applies?

Path: Review the official 7th-character definitions for this family in the 7th Character Guide.

Reason: “Initial encounter” means active treatment, not the first visit; care during recovery takes “subsequent encounter”, and a complication arising from the original condition takes “sequela” (Guidelines I.C.19.a).

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

ReviewS14.0, S14.1

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Other fracture of first cervical vertebra is a non-billable ICD-10-CM category code (S12.09). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. Sequencing: 1 Code First instruction — the underlying condition is sequenced before this code when present. See the Code First notes
  3. 7 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name S12.09 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes: M48.4 — Fatigue fracture of vertebra (via S12.-), M48.5 — Collapsed vertebra, not elsewhere classified (via S12.-), M84.3 — Stress fracture (via S12.-), M84.4 — Pathological fracture, not elsewhere classified (via S12.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 3 Excludes2 notes: S11 — Open wound of neck (via S12.-), S13.1 — Subluxation and dislocation of cervical vertebrae (via S12.-), S27 — Injury of other and unspecified intrathoracic organs (via S12.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 2 Use Additional Code instructions: S17 — Crushing injury of neck (via S12.0.-), T71.16 — Asphyxiation due to hanging (via S12.-).

These codes instruct coders to additionally report this code when it applies.

Referenced by 1 Code Also instruction: S14 — Injury of nerves and spinal cord at neck level (via S12.0.-).

These codes suggest coding this condition alongside when both are present.

Contextual Map

Every relationship of S12.09 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run S12.09 with these 10 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Use Additional Code instructions

  • S17 — Crushing injury of neck[Use Additional Code](via S12.0.-): “vertebral fracture (S12.0--S12.3-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
  • T71.16 — Asphyxiation due to hanging[Use Additional Code](via S12.-): “fracture of cervical vertebrae (S12.0-S12.2-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code Also instructions

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Can S12.09 be billed directly?

No. S12.09 (Other fracture of first cervical vertebra) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does S12.09 require a 7th character?

Yes. The appropriate 7th character is to be added to all codes from subcategories S12.0-S12.6.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other fracture of first cervical vertebra

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S12.09 in its code family, with their registry titles.

View all codes in the S12 family