S14.111D

🧬 ICD-10 CM S14.111D — Complete Lesion at C1 Level of Cervical Spinal Cord, Subsequent Encounter

Billable Code Confirmed

ICD-10 CM S14.111D is a 7-character code: S14.1 is injury of cervical spinal cord, S14.11 is complete lesion, the 6th character 1 is the C1 level, and D is subsequent encounter. It is a valid, billable code for FY2026.^1,2

Non-Billable Parent Codes

S14.111 (Complete lesion at C1 level of cervical spinal cord) is a non-billable code that lacks the 7th character. S14.11 (Complete lesion of cervical spinal cord) and S14.1 (Injury of cervical spinal cord) are non-billable headers that lack level and encounter character.²

Clinical Context

The record has to document both the level (C1) and the completeness of the lesion, because those two details drive the 6th character and the HCC. An incomplete lesion at C1 or a different level would move to a different S14.1 code.

Code Classification

This is an ICD-10-CM diagnosis code from the Injury chapter, and it is not a procedure code.

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🔍 Code Description

ICD-10 CM S14.111D describes a complete lesion of the cervical spinal cord at C1, meaning no preserved motor or sensory function below the injury level. In rehab it is the injury code that supports the impairment being treated, and the functional picture is usually described with quadriplegia codes such as G82.51.³ The S14 category carries a “code also” note for associated cervical vertebral fracture (S12.0- to S12.6-), open wound of neck (S11.-), and transient paralysis R29.5.²

At C1 the patient’s care typically centers on ventilator dependence, autonomic instability, bladder and bowel management, and skin protection, so these conditions are commonly reported alongside the injury code. Examples are Z99.11, G90.4, N31.9, and K59.2. The 7th characters available for S14.111 are A, D, and S, so S14.111A and S14.111S are the other encounter types.²

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🌳 Code Tree / Hierarchy

S14 Injury of nerves and spinal cord at neck level ❌ Non-billable
│
├── S14.1 Injury of cervical spinal cord ❌ Non-billable
│ │
│ ├── S14.10 Unspecified injury of cervical spinal cord ❌ Non-billable
│ │ │
│ │ └── S14.101D Unspecified injury at C1 level of cervical spinal cord, subsequent encounter ✅ Billable
│ │
│ ├── S14.11 Complete lesion of cervical spinal cord ❌ Non-billable
│ │ │
│ │ ├── S14.111 Complete lesion at C1 level of cervical spinal cord ❌ Non-billable
│ │ │ │
│ │ │ ├── S14.111A Initial encounter ✅ Billable
│ │ │ ├── S14.111D Subsequent encounter ◀ THIS CODE ✅ Billable
│ │ │ └── S14.111S Sequela ✅ Billable
│ │ │
│ │ ├── S14.112 Complete lesion at C2 level of cervical spinal cord ❌ Non-billable
│ │ │ │
│ │ │ └── S14.112D Subsequent encounter ✅ Billable
│ │ │
│ │ └── S14.113 Complete lesion at C3 level of cervical spinal cord ❌ Non-billable
│ │   │
│ │   └── S14.113D Subsequent encounter ✅ Billable
│ │
│ └── S14.12 Central cord syndrome of cervical spinal cord ❌ Non-billable
│   │
│   └── S14.121D Central cord syndrome at C1 level, subsequent encounter ✅ Billable

Level and Completeness Drive the Code

A note that says only “cervical SCI” or “tetraplegia” will not reach S14.111D, and it may fall to an unspecified-level code such as S14.101D. Query for the neurologic level, the ASIA impairment grade, and whether the lesion is complete.

Tip

Quadriplegia codes in G82.5- describe the functional result and are used alongside the S14 injury code when documented. Do not use them to replace the injury code.

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✅ Includes

• The S14 “code also” note applies to any associated fracture of cervical vertebra (S12.0- to S12.6-), open wound of neck (S11.-), and transient paralysis R29.5.²
• A documented complete transection or ASIA A injury at C1 supports S14.111D when the lesion level and completeness are stated.

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❌ Excludes

Excludes 1

• No code-level Excludes1 note was retrieved for S14.111D. Verify section-level S14 notes in your encoder.

Danger

The most common error is choosing an incomplete-lesion or unspecified-level code when the provider documents a complete C1 injury. A second error is leaving out the “code also” conditions, such as the associated cervical fracture.

Excludes 2

• Associated injuries and complications are coded separately when documented, including cervical vertebral fracture, open wound of neck, and transient paralysis. Confirm the exact notes at S14 in your encoder.

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📋 Clinical Overview

Level and Completeness

Complete high cervical injuries are classified by level (C1 through C8) in the 6th character, and by completeness in the S14.1 subcategory. The level affects the likely deficits: at C1 the patient typically has the highest degree of motor and sensory loss and often needs ventilatory support.³

Feature	S14.111D	Related S14.112D	Related S14.121D
Lesion type	Complete lesion.	Complete lesion.	Central cord syndrome (incomplete).
Level	C1.	C2.	C1.
Documentation key	Provider states complete lesion and C1 level.	Provider states complete lesion and C2 level.	Provider states central cord syndrome at C1.

Important

A CDI trigger is “tetraplegia” or “cervical cord injury” with no level or ASIA grade. Query for the neurologic level of injury and the ASIA grade so the correct level and completeness code is assigned.

Manifestations & Symptom Burden

• Quadriplegia with loss of motor and sensory function below the injury, coded with G82.51 when documented.
• Ventilator dependence or respiratory insufficiency, coded with Z99.11 when applicable.
• Autonomic dysreflexia, coded with G90.4 when documented.
• Neurogenic bladder and bowel, coded with N31.9 and K59.2 when documented.
• Pressure injury risk and spasticity, coded only when the provider documents a current condition.

Tip

Each manifestation needs its own provider documentation. Do not assume it from the level of injury.

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💰 HCC Risk Adjustment

Field	Value
ICD-10-CM Code	S14.111D
HCC Category	HCC 180 — Quadriplegia (CMS-HCC V28)3,4
RAF Impact	High-value category in V28 for Medicare Advantage
Annual Capture	Document and code at a face-to-face encounter each calendar year
Payer Note	Confirm the current-year mapping and coefficients with CMS and your payer

The V28 mapping lists S14.111A, S14.111D, and S14.111S under HCC 180.³ The G82.5- quadriplegia codes also map to the same category, so reporting both does not stack the HCC. Check the current CMS model software mapping for your payment year.⁶

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🏥 MS-DRG Assignment

Field	Value
MDC (acute-care reference)	MDC 01 — Nervous System (verify)
DRG with CC/MCC	052 — Spinal Disorders and Injuries with CC/MCC (verify)
DRG without CC/MCC	053 — Spinal Disorders and Injuries without CC/MCC (verify)
IRF impairment group (traumatic)	04.2221 — Quadriplegia, Complete C1-4 (verify in current IRF-PAI manual)5

In inpatient rehab, the IRF-PAI impairment group and functional scores place the patient in a case-mix group, so MS-DRG does not set payment. The IRF-PAI manual lists “Quadriplegia, Complete C1-4” under traumatic spinal cord dysfunction.⁵ I did not verify the MS-DRG grouping for this code.

• LCD/NCD: I found no NCD or LCD specific to this code.
• IRF admissions are also subject to the Medicare IRF coverage criteria, so review the current Medicare Benefit Policy Manual chapter on inpatient rehabilitation facility services.

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🔗 Related ICD-10-CM Codes

Same injury, other encounter types and quadriplegia: S14.111A, S14.111S, G82.51, G82.52^2,3

Related level and rehab conditions: S14.112D, S14.113D, S14.121D, S14.101D, Z99.11, G90.4, N31.9, K59.2¹

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🛠️ Commonly Associated CPT Codes

• 99223: Initial hospital inpatient or observation care, high level. It is used for the admission H&P when the physician performs the initial IRF evaluation.
• 99233: Subsequent hospital inpatient care, high level. It supports management of a medically complex patient with high-level SCI.
• 99232: Subsequent hospital inpatient care, moderate level. It covers routine rehab rounds with active medical management.
• 99231: Subsequent hospital inpatient care, straightforward or low level. It covers brief follow-up when the patient is stable.
• 99238: Hospital discharge day management, 30 minutes or less. It is used for a shorter discharge-day service.
• 99239: Hospital discharge day management, more than 30 minutes. It requires documented total time.

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🏷️ Modifier Reference

Modifier	Name	When to Apply
-AI	Principal Physician of Record	Use on the initial hospital care E/M by the admitting or attending physician who oversees the patient’s care, when billing Medicare.
-25	Significant E/M	Use when a significant, separately identifiable E/M is performed on the same day as a procedure. Documentation must support both services.
-51	Multiple Procedures	Use on lower-valued procedures when several are performed in the same session, unless the code is modifier-51 exempt.
-59	Distinct Service	Use to show a separate site or session when NCCI would otherwise bundle the codes, and only when documentation supports it.

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NCCI Bundling Considerations

Hospital E/M visits are generally not bundled with each other on different dates. Check NCCI PTP edits before reporting a procedure on the same day as an E/M, and confirm payer rules for discharge-day management combined with other same-day services.

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🔬 ICD-10-PCS Crosswalk

ICD-10 CM S14.111D is a diagnosis for ongoing care and has no direct PCS match. For rehab stays, procedures are typically captured by the acute-care facility, and PCS applies mainly to the facility record.

• 00 (Central Nervous System and Cranial Nerves, Medical and Surgical): Table root for spinal cord procedures, such as decompression or exploration. Select the full 7-character code from the current PCS tables.
• 0RG (Fusion, Upper Joints): Table root for cervical spinal fusion performed during the acute stay. Select the full 7-character code from the current PCS tables.

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💊 Coding Scenarios and Examples

Example 1

Clinical Scenario:
A patient with a complete C1 spinal cord injury is admitted to inpatient rehab. The attending physiatrist completes the admission history and physical with a high-complexity medical decision.

Field	Code	Rationale
CPT	99223--AI	Initial hospital care by the principal physician of record.
PDx	S14.111D	Complete C1 lesion being treated in rehab.
Dx 2	G82.51	Quadriplegia documented as the functional result.

Tip

Sequence S14.111D first as the injury, followed by the functional and associated conditions. CDI: confirm the level, completeness, and ASIA grade are all documented.

Example 2

Clinical Scenario:
On hospital day 10, the physiatrist manages autonomic dysreflexia episodes, ventilator weaning status, and a neurogenic bladder regimen.

Field	Code	Rationale
CPT	99233	High-level subsequent hospital care for multiple active, complex problems.
PDx	S14.111D	Injury being managed in the rehab stay.
Dx 2	G90.4	Autonomic dysreflexia documented and actively managed.
Dx 3	N31.9	Neurogenic bladder documented and managed.

Tip

Report each secondary condition only when the provider documents it as monitored or treated that day. CDI: document the management plan for each problem to support the E/M level.

Example 3

Clinical Scenario:
The physiatrist completes discharge day management for a patient going home with equipment and a caregiver plan, spending 40 minutes in total.

Field	Code	Rationale
CPT	99239	Discharge day management over 30 minutes, supported by documented time.
PDx	S14.111D	Injury treated during the rehab stay.
Dx 2	G82.51	Quadriplegia documented at discharge.

Tip

Document total discharge-day time to support 99239 over 99238. CDI: record the discharge condition and follow-up plan, including the functional status.

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⚠️ Coding Pitfalls and Tips

• Pitfall 1: Choosing S14.101D (unspecified injury) when the record documents a complete C1 lesion; Tips: Read the neurosurgery notes and ASIA exam, and query for level and completeness.
• Pitfall 2: Reporting only G82.51 and leaving out the injury code; Tips: Report S14.111D as the injury, and add the quadriplegia code as a functional descriptor.
• Pitfall 3: Using an incomplete-lesion or central cord code when the provider writes “complete”; Tips: Match the code to the documented completeness and grade.
• Pitfall 4: Missing the “code also” conditions such as cervical vertebral fracture; Tips: Check the trauma and neurosurgery notes for fractures, and code them per the S12 rules.
• Pitfall 5: Reporting manifestations such as G90.4 or N31.9 without provider documentation of a current condition; Tips: Code only conditions that are documented as evaluated, monitored, or treated.
• Pitfall 6: Assuming MS-DRG drives payment for IRF stays; Tips: Treat the IRF-PAI impairment group and function scores as the payment drivers, and verify the current manual.

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📚 Sources

1. ICD10Data.com. *2026 ICD-10-CM Diagnosis Code S14.111D.* https://www.icd10data.com/ICD10CM/Codes/S00-T88/S10-S19/S14-/S14.111D 2. AAPC. *ICD-10 code S14.111D for Complete lesion at C1 level of cervical spinal cord, subsequent encounter.* https://www.aapc.com/codes/icd-10-codes/S14.111D 3. HCC Buddy. *CMS-HCC V28 HCC 180: Quadriplegia.* https://hccbuddy.com/hcc/v28/180 4. ICD List. *HCC 180 ICD-10 Codes 2026: Quadriplegia.* https://icdlist.com/icd-10/hcc/180 5. Centers for Medicare & Medicaid Services. *IRF-PAI Training Manual (2012), impairment group codes.* https://www.cms.gov/medicare/medicare-fee-for-service-payment/inpatientrehabfacpps/downloads/irfpai-manual-2012.pdf 6. Centers for Medicare & Medicaid Services. *2026 Model Software/ICD-10 Mappings.* https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings

_{Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.}