S43.80XS vs S46
S43.80XS (Sprain of other specified parts of unspecified shoulder girdle, sequela) compared with S46 (Injury of muscle, fascia and tendon at shoulder and upper arm level), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Can these codes be reported together?
Yes, when both are documented. S43.80XS carries an Excludes2 note covering S46: “strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| S43.80XSSprain of other specified parts of unspecified shoulder girdle, sequela | S46Injury of muscle, fascia and tendon at shoulder and upper arm level | |
|---|---|---|
| Billing status | Billable | Non-billable header Report instead: S46.001A, S46.001D, S46.001S, S46.002A, S46.002D |
| 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 other specified parts of unspecified shoulder girdle, sequela is a billable ICD-10-CM diagnosis code (S43.80S). | Injury of muscle, fascia and tendon at shoulder and upper arm level is a non-billable ICD-10-CM category code (S46). |
| 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 S46 |
| 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 | injuries of axilla injuries of scapular region |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources