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S43.422 vs S46.0

S43.422 (Sprain of left rotator cuff capsule) compared with S46.0 (Injury of muscle(s) and tendon(s) of the rotator cuff of shoulder), 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 can be reported together when both conditions are documented, because S43.422 lists S46.0 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named.S43.422 is “Sprain of left rotator cuff capsule”; S46.0 is “Injury of muscle(s) and tendon(s) of the rotator cuff of shoulder”.

Registry fact

Can these codes be reported together?

Yes, when both are documented.S43.422 lists S46.0 under Excludes2: “injury of tendon of rotator cuff (S46.0-)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

Yes.S43.422’s tabular entry: “injury of tendon of rotator cuff (S46.0-)”. The note covers S46.0.

Official ruleGuide: Excludes1 vs Excludes2

Is one a parent or header code?

Both are headers.Both are non-billable headers, and neither contains the other.

Registry fact

Nothing found in 3 other checks; 1 check does not apply
Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code. S43.422 carries 1 Excludes1 note 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?

Informational

Excludes2 relationship

S43.422
Sprain of left rotator cuff capsule
↔
S46.0
Injury of muscle(s) and tendon(s) of the rotator cuff of shoulder

What we found

Yes, when both are documented.S43.422 carries an Excludes2 note covering S46.0: “injury of tendon of rotator cuff (S46.0-)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    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
S43.422

Sprain of left rotator cuff capsule

S46.0

Injury of muscle(s) and tendon(s) of the rotator cuff of shoulder

StatusDiffers
S43.422
Non-billable header

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

Report instead: S43.422A, S43.422D, S43.422S

S46.0
Non-billable header

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

Report instead: S46.001A, S46.001D, S46.001S, S46.002A, S46.002D

Excludes1Differs
S43.422
  • rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)
S46.0

None at this code

Excludes2Differs
Only at S43.422
  • injury of tendon of rotator cuff (S46.0-)
  • strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)
Only at S46.0
  • injury of muscle, fascia and tendon at elbow (S56.-)
  • sprain of joints and ligaments of shoulder girdle (S43.9)
Shared by both codes (4 notes)
  • burns and corrosions (T20-T32)
  • frostbite (T33-T34)
  • injuries of elbow (S50-S59)
  • insect bite or sting, venomous (T63.4)
Code alsoDiffers
S43.422
  • any associated open wound
S46.0
  • any associated open wound (S41.-)
CategoryDiffers
S43.422

S43 Dislocation and sprain of joints and ligaments of shoulder girdle

S46.0

S46 Injury of muscle, fascia and tendon at shoulder and upper arm level

ChapterSame for both

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

IncludesDiffers
Only at S43.422
  • 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
Only at S46.0

No note of its own beyond the shared notes

Shared by both codes (2 notes)
  • injuries of axilla
  • injuries of scapular region
7th characterDiffers
S43.422
  • The appropriate 7th character is to be added to each code from category S43
S46.0
  • The appropriate 7th character is to be added to each code from category S46

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