ICD code S24.114D – Complete thoracic cord lesion, level T11-T12

Key takeaways

S24.114D codes a complete lesion at the T11-T12 level of the thoracic spinal cord, subsequent encounter. Complete means AIS grade A, with no motor or sensory function below the lesion.

The T11-T12 level is the neurological (cord) level, not the fractured vertebra, so a T12 fracture alone never decides the code.

Seventh character D applies once active treatment has ended and the patient receives routine care during healing or recovery, including rehabilitation.

The record must name a complete injury, state the T11-T12 neurological level, and show that active treatment is over.

Pabau, the practice software we build, scrubs each claim before it reaches Claim.MD and flags rejections with the reason, so coding errors get fixed fast.

ICD-10 code S24.114D: What it means and who uses it

ICD-10 code S24.114D is the billable diagnosis code for a complete lesion at the T11-T12 level of the thoracic spinal cord, subsequent encounter. It sits in Chapter 19 of ICD-10-CM, under category S24, injury of nerves and spinal cord at thorax level.

The code describes a complete traumatic spinal cord injury in the lowest thoracic cord segments. The seventh character D shows that active treatment is over. The patient is now receiving routine care while the injury heals or recovers.

Inpatient rehabilitation facilities, outpatient rehabilitation teams, physiatrists, and the physicians who manage follow-up care typically report it. It is valid in the FY2027 code set, effective October 1, 2026, and must be reported with all seven characters.

Code descriptor breakdown

Each character in S24.114D narrows the diagnosis. The table below translates the code into plain English, using the official ICD-10-CM tabular titles.

The sixth character works the same way across S24.1. The values are 1 for T1, 2 for T2-T6, 3 for T7-T10, 4 for T11-T12, and 9 for an unspecified level. Other injury codes follow the same build, and the diagnostic codes library breaks each one down by character.

Clinical definition: Complete lesion of the thoracic spinal cord

A complete lesion means no motor or sensory function is preserved below the neurological level of injury. That includes the lowest sacral segments, S4-S5. Under the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), this is ASIA Impairment Scale (AIS) grade A.

Some patients keep partial function in a few segments just below the level. The examiner records this as the zone of partial preservation, and the injury is still complete. Any sacral sparing, by contrast, makes the injury incomplete (AIS B to D), which moves it out of S24.11.

A complete lesion at T11-T12 typically causes paraplegia. Leg movement and sensation are lost, while arm function and most trunk control remain. Neurogenic bladder and bowel are expected and shape much of the follow-up care.

T11-T12 is the cord level, not the bone level

A tabular note under category S24 states that S24.0 and S24.1 codes refer to the cord level, not the bone level. The level in S24.114D therefore comes from the neurological examination, not from the fracture on imaging.

The distinction matters at the thoracolumbar junction. In the lower thoracic spine, cord segments sit higher than the vertebrae with the same number. A T12 burst fracture can injure lumbar or sacral cord segments, which are coded in category S34, not S24.

Two more tabular rules apply. Code to the highest level of thoracic cord injury documented. Then code any associated fracture of a thoracic vertebra separately, such as S22.08-, fracture of T11-T12 vertebra.

Seventh character D: Subsequent encounter rules for S24.114D

The seventh character D is used after the patient has completed active treatment and is receiving routine care during the healing or recovery phase. That is the wording of the ICD-10-CM Official Guidelines for Coding and Reporting for Chapter 19.

The choice turns on the type of care, not on the provider. A new physician or facility does not reset the seventh character to initial encounter. The same guidelines also say aftercare Z codes are not used for injuries. Aftercare for this injury is reported with S24.114D itself.

A vs D vs S: Choosing the right seventh character

The three seventh-character options for S24.114 are often confused. The table below matches each one to its clinical scenario.

Code also notes, Excludes2, and related codes for S24.114D

S24.114D inherits the instructional notes of category S24. They tell the coder what else to report and what sits outside the category.

• Code also (S24): Any associated fracture of thoracic vertebra (S22.0-), open wound of thorax (S21.-), or transient paralysis (R29.5).
• Excludes2 (S24): Injury of brachial plexus (S14.3). Both conditions can be coded together when both are present.
• Level rule: Code to the highest level of thoracic spinal cord injury, using the cord level rather than the bone level.
• Non-traumatic cord damage: Spinal cord infarction or other non-traumatic myelopathy belongs in chapter 6 (for example, G95.11), not in category S24.

Codes to report alongside S24.114D

The CDC/NCHS ICD-10-CM browser tool and the official guidelines define which supporting codes travel with an injury code on a subsequent encounter.

• External cause code (V00-Y99): Reported with the same seventh character as the injury, for example V49.9XXD, car occupant injured in unspecified traffic accident, subsequent encounter.
• Reporting status: There is no national mandate for external cause codes. A state mandate or a payer contract can still require them, so check each payer.
• Place, activity, and status codes (Y92, Y93, Y99): Each is reported only once, at the initial encounter. They do not belong on S24.114D claims.
• Conditions treated at the visit: Report them where documented, such as N31.9, neuromuscular dysfunction of bladder, unspecified, or K59.2, neurogenic bowel.

Commonly confused codes: S24.114D vs nearby spinal cord codes

S24.114D sits beside codes that share its level or its lesion type, and those neighbors are easy to confuse. The table below compares it with its nearest neighbors, all subsequent encounter, using official CMS descriptors.

Three checks, run in order, settle which of these codes fits the record.

S24.114D vs S24.104D: The specificity decision

ICD-10-CM asks for the most specific code the record supports. S24.104D fits when the physician documents a cord injury at T11-T12 but never says whether it is complete.

If the record states a complete injury or AIS grade A at T11-T12, S24.114D is correct and S24.104D undercodes it. If the record is unclear, query the provider. Code assignment rests on the provider’s diagnostic statement, not on the coder’s reading of the exam.

Documentation requirements to support S24.114D

A claim for ICD-10 code S24.114D needs a record that supports each part of the code. Auditors look for each of these elements. A grounding in medical billing fundamentals helps practices build records that hold up.

• A complete injury: The physician documents a complete spinal cord injury or AIS grade A. An ISNCSCI worksheet showing no sacral sparing supports it.
• The neurological level: The record names a neurological level of T11 or T12. A fracture level on imaging is not enough.
• The encounter type: Notes show that active treatment has ended and the visit is routine care during healing or recovery.
• The cause of injury: A short account of how the injury happened supports the external cause code where a payer requires one.
• Conditions treated: Bladder, bowel, skin, or spasticity problems addressed at the visit are documented so they can be coded.

Payer requirements and denial prevention for S24.114D claims

Medicare and commercial payers apply the standard Chapter 19 rules to S24.114D. Denial risk sits in three places. They are the seventh character, the level, and a lesion type the record does not support.

Top reasons S24.114D claims are denied

• A instead of D: Reporting S24.114A for a rehabilitation or follow-up visit conflicts with the care the notes describe.
• Bone level coded as cord level: A T11 or T12 fracture on imaging does not establish a T11-T12 cord injury.
• Incomplete injury coded as complete: An ISNCSCI exam showing sacral sparing (AIS B to D) contradicts S24.114D.
• Mismatched external cause code: An external cause code with A beside an injury code with D fails consistency edits.
• Place of service conflict: The place of service on the claim must match the setting in the notes.

Rehabilitation facility billing with S24.114D

Inpatient rehabilitation facilities (IRFs) commonly bill S24.114D. Once acute care ends and the patient moves to rehabilitation, the injury code takes D, not A.

For IRF payment, the IRF-PAI impairment group drives the case-mix group. The etiologic diagnosis code should agree with it, so a complete paraplegia impairment group fits S24.114D. A mismatch between the two invites review.

Rehabilitation teams should confirm the neurological level and AIS grade before the first rehabilitation claim goes out.

Coding guidelines and official references for S24.114D

These sources settle most S24.114D questions. Each one covers a different layer of the coding decision.

• CMS ICD-10-CM files: The annual code descriptions, tabular list, and Official Guidelines for Coding and Reporting.
• Official Guidelines, Section I.C.19: The rules for injury codes, including the A, D, and S seventh characters and aftercare for injuries.
• Official Guidelines, Section I.C.20: The rules for external cause codes, including the once-only place, activity, and status codes.
• AHA Coding Clinic for ICD-10-CM/PCS: The American Hospital Association’s quarterly guidance on specific coding scenarios, issued with the Cooperating Parties.
• ISNCSCI: The examination standard behind AIS grades and neurological levels, which the record needs for S24.114D.
• Denial management in healthcare: The wider workflow for reducing payer denials, including provider queries.
• Clean claim requirements: The claim-level checks that prevent front-end rejections for injury codes.

How Pabau reduces claim errors for S24.114D

Spinal cord injury follow-up produces a long run of claims for the same diagnosis. When each one is checked by hand, one wrong seventh character can repeat across weeks of visits.

Pabau’s claims management software submits CMS-1500 claims through its Claim.MD clearinghouse integration. It scrubs each claim for missing or invalid details before it leaves Pabau. A rejected claim is flagged as needing action, with the reason shown, so your team can correct and resubmit it.

Payments then settle from electronic remittance advice files. Your billers spend less time chasing S24.114D claims and more time on the documentation that supports them.

Catch spinal cord injury claim errors early

Pabau scrubs each claim before it reaches Claim.MD and flags rejections with the reason, so S24.114D errors get fixed before they repeat.

Book a demo

Conclusion

S24.114D is narrow by design. It fits only a complete injury, at the T11-T12 cord level, after active treatment has ended. When the record proves all three, the code is easy to defend.

The risk sits in the inputs. A fracture level, a vague exam, or an A carried over from the hospital will each undo the claim. Settle the level and AIS grade at the first rehabilitation visit, and every claim after it inherits a clean diagnosis.

Pabau’s electronic remittance advice workflows show payer responses alongside the original claim, so a pattern across S24.114D claims is visible early. Book a demo to see how Pabau handles billing for spinal cord injury care.

Continue your research

Need a framework for reducing injury code denials? Denial codes in medical billing covers the most common CARC codes your team will see after an S24.114D rejection and how to address each one.

Billing for spinal cord injury patients across care transitions? Claim.MD clearinghouse overview explains how real-time eligibility verification and 837P submission work together to reduce front-end rejections.

Looking to verify payer eligibility before the encounter? Insurance eligibility verification outlines the pre-visit checks that prevent encounter-type mismatches and missing coverage issues on SCI claims.

Frequently asked questions