S33.5XXA (Sprain of ligaments of lumbar spine, initial encounter) compared with S33.5XXD (Sprain of ligaments of lumbar spine, subsequent encounter), from the official CMS tabular data. S33.5XXA and S33.5XXD code the same injury at a different phase of treatment.
Same underlying diagnosis, different encounter phase.
The 7th character records the phase of care for the encounter being coded, so a single encounter takes one of these characters, not several. Review whether both phases belong on the same episode of care.
Source: ICD-10-CM Official Guidelines, Section I.C.19.a
Same injury, other encounter phase. S33.5XXA and S33.5XXD code the same injury at a different phase of treatment, set by the 7th character.
The 7th character records the type of care given at the encounter being coded (ICD-10-CM Official Guidelines, Section I.C.19.a), so one encounter takes one of these, not both.
| S33.5XXASprain of ligaments of lumbar spine, initial encounter | S33.5XXDSprain of ligaments of lumbar spine, subsequent encounter | |
|---|---|---|
| Billing status | Billable | Billable |
| Classification | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Sprain of ligaments of lumbar spine, initial encounter is a billable ICD-10-CM diagnosis code (S33.5A). | Sprain of ligaments of lumbar spine, subsequent encounter is a billable ICD-10-CM diagnosis code (S33.5D). |
| 7th character | The appropriate 7th character is to be added to each code from category S33 | The appropriate 7th character is to be added to each code from category S33 |
| Includes | avulsion of joint or ligament of lumbar spine and pelvis laceration of cartilage, joint or ligament of lumbar spine and pelvis sprain of cartilage, joint or ligament of lumbar spine and pelvis traumatic hemarthrosis of joint or ligament of lumbar spine and pelvis | avulsion of joint or ligament of lumbar spine and pelvis laceration of cartilage, joint or ligament of lumbar spine and pelvis sprain of cartilage, joint or ligament of lumbar spine and pelvis traumatic hemarthrosis of joint or ligament of lumbar spine and pelvis |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources