S12.040B
ICD-10-CMDisplaced lateral mass fracture of first cervical vertebra, initial encounter for open fracture
This code describes a fracture of the lateral mass of the C1 (atlas) vertebra that is out of its normal anatomical alignment and has an associated open wound, indicating a direct communication between the fracture site and the external environment. This injury often results from significant axial loading or hyperextension forces applied to the head and neck.
Use this code for the initial treatment of a patient presenting with a displaced lateral mass fracture of the C1 vertebra where the fracture is open. Documentation must clearly specify "displaced," "lateral mass," "C1," and "open fracture" in the medical record. This code is appropriate for the acute phase of injury management, including surgical repair or initial stabilization.
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