S43.422A (Sprain of left rotator cuff capsule, initial encounter) compared with S43.422D (Sprain of left rotator cuff capsule, subsequent encounter), from the official CMS tabular data. S43.422A and S43.422D code the same injury at a different phase of treatment. MedCoder-derived
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. S43.422A and S43.422D 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.
| S43.422ASprain of left rotator cuff capsule, initial encounter | S43.422DSprain of left rotator cuff capsule, subsequent encounter | |
|---|---|---|
| Billing status | Billable | Billable |
| Classification | S00-T88 — Injury, poisoning and certain other consequences of external causes | S00-T88 — Injury, poisoning and certain other consequences of external causes |
| Definition | Sprain of left rotator cuff capsule, initial encounter is a billable ICD-10-CM diagnosis code (S43.422A). | Sprain of left rotator cuff capsule, subsequent encounter is a billable ICD-10-CM diagnosis code (S43.422D). |
| 7th character | The appropriate 7th character is to be added to each code from category S43 | The appropriate 7th character is to be added to each code from category S43 |
| Includes | 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 | 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