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M75.1 vs S43.421S

M75.1 (Rotator cuff tear or rupture, not specified as traumatic) compared with S43.421S (Sprain of right rotator cuff capsule, sequela), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes should not be reported together because S43.421S’s tabular entry lists M75.1 under Excludes1.

Official rule
What is different?

The conditions named, billing status and chapter.M75.1 is “Rotator cuff tear or rupture, not specified as traumatic”; S43.421S is “Sprain of right rotator cuff capsule, sequela”. M75.1 is a non-billable header; S43.421S is billable. M75.1 sits in M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99); S43.421S in S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88).

Registry fact

Can these codes be reported together?

No.S43.421S’s entry carries an Excludes1 note covering M75.1: “rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.S43.421S’s tabular entry: “rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)”. The note covers M75.1.

Official ruleGuide: Excludes1 vs Excludes2

Is one a parent or header code?

One is a header.M75.1 is a non-billable header, but S43.421S is not one of its subdivisions.

Registry fact

Nothing found in 3 other checks; 1 check does not apply
Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. M75.1 carries 1 Excludes2 note and S43.421S carries 6 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Excludes1 — generally not reported together

Excludes1 conflict

S43.421S
Sprain of right rotator cuff capsule, sequela
↔
M75.1
Rotator cuff tear or rupture, not specified as traumatic

What we found

No — do not report together.S43.421S 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).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
M75.1

Rotator cuff tear or rupture, not specified as traumatic

S43.421S

Sprain of right rotator cuff capsule, sequela

StatusDiffers
M75.1
Non-billable header

A header is not reported on a claim; a code beneath it is.

Report instead: M75.100, M75.101, M75.102, M75.110, M75.111

S43.421S
Billable
Excludes1Differs
M75.1
  • tear of rotator cuff, traumatic (S46.01-)
S43.421S
  • rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)
Excludes2Differs
M75.1
  • shoulder-hand syndrome (M89.0-)
S43.421S
  • injury of tendon of rotator cuff (S46.0-)
  • strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)
  • burns and corrosions (T20-T32)
  • frostbite (T33-T34)
  • injuries of elbow (S50-S59)
  • insect bite or sting, venomous (T63.4)
Code alsoDiffers
M75.1

None at this code

S43.421S
  • any associated open wound
CategoryDiffers
M75.1

M75 Shoulder lesions

S43.421S

S43 Dislocation and sprain of joints and ligaments of shoulder girdle

ChapterDiffers
M75.1

M00-M99 — Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)

S43.421S

S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)

IncludesDiffers
M75.1
  • Rotator cuff syndrome
  • Supraspinatus tear or rupture, not specified as traumatic
  • Supraspinatus syndrome
S43.421S
  • 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
  • traumatic rupture of joint or ligament of shoulder girdle
  • traumatic subluxation of joint or ligament of shoulder girdle
  • traumatic tear of joint or ligament of shoulder girdle
  • injuries of axilla
  • injuries of scapular region
7th characterDiffers
M75.1

None at this code

S43.421S
  • The appropriate 7th character is to be added to each code from category S43

No Code first and Use additional code note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, each code’s own notes are listed under it, and the notes every code shares are listed once beneath them.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources