S12.290B ICD-10-CM Code: Other displaced fracture of third cervical vertebra, initial encounter for open fracture
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FY 2026 Apr update / Injury, poisoning and certain other consequences of external causes (S00-T88) / Injuries to the neck (S10-S19)
S12.290B
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther displaced fracture of third cervical vertebra, initial encounter for open fracture
Other displaced fracture of third cervical vertebra, initial encounter for open fracture
CMS-HCC V28
MappedHCC 401
RAF 0.910
CMS-HCC V24
MappedHCC 169
RAF 0.416
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 169
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for S12.290B in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for S12.290B in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for S12.290B in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for S12.290B in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for S12.290B in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for S12.290B in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for S12.290B in this effective period.
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is S12.290B an HCC code?
Yes. S12.290B maps to Vertebral Fractures without Spinal Cord Injury under the CMS-HCC V28 risk adjustment model (and Vertebral Fractures without Spinal Cord Injury under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for S12.290B
For S12.290Bto count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed S12.290B during that encounter, not just copy-forwarded from a problem list.
What This Code Means
S12.290B is the ICD-10-CM diagnosis code for other displaced fracture of third cervical vertebra, initial encounter for open fracture. S12.290B sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering injuries to the neck (s10-s19).
Under the CMS-HCC V28 risk adjustment model, S12.290B maps to Vertebral Fractures without Spinal Cord Injury (HCC 401) with a community, non-dual, aged base RAF weight of 0.910. Under the older V24 model, S12.290B mapped to the same category but with a base RAF weight of 0.416, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Coders should report S12.290B only when the provider documentation supports the specific condition described, since more specific codes within the same hierarchy can capture additional clinical detail and may carry a higher RAF weight. Because S12.290B maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for S12.290B sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.