M75.1 vs S43.42
M75.1 (Rotator cuff tear or rupture, not specified as traumatic) compared with S43.42 (Sprain of rotator cuff capsule), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. S43.42 carries an Excludes1 note covering M75.1: “rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| M75.1Rotator cuff tear or rupture, not specified as traumatic | S43.42Sprain of rotator cuff capsule | |
|---|---|---|
| Billing status | Non-billable header | Non-billable header Report instead: S43.421A, S43.421D, S43.421S, S43.422A, S43.422D |
| Classification | M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Rotator cuff tear or rupture, not specified as traumatic is a non-billable ICD-10-CM category code (M75.1). | Sprain of rotator cuff capsule is a non-billable ICD-10-CM category code (S43.42). |
| 7th character | — | The appropriate 7th character is to be added to each code from category S43 |
| Includes | Rotator cuff syndrome Supraspinatus tear or rupture, not specified as traumatic Supraspinatus syndrome | avulsion of joint or ligament of shoulder girdle laceration of cartilage, joint or ligament of shoulder girdle sprain of cartilage, joint or ligament of shoulder girdle traumatic hemarthrosis of joint or ligament of shoulder girdle |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources