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S43.016 ICD-10-CM Code: Anterior dislocation of unspecified humerus

Compare with another codeCheck this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
9 inclusion terms · 5 Excludes2 · 1 code-also instruction

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Code alsoMay be needed with this code
  • any associated open wound
Excludes2Not included here; may be reported together
  • 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)

+1 more in Instructions

IncludesWhat this code covers
  • 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

+5 more in Instructions

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for S43.016 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on S43.016 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • avulsion of joint or ligament of shoulder girdle inherited from S43
  • laceration of cartilage, joint or ligament of shoulder girdle inherited from S43
  • sprain of cartilage, joint or ligament of shoulder girdle inherited from S43
  • traumatic hemarthrosis of joint or ligament of shoulder girdle inherited from S43
  • traumatic rupture of joint or ligament of shoulder girdle inherited from S43
  • traumatic subluxation of joint or ligament of shoulder girdle inherited from S43
  • traumatic tear of joint or ligament of shoulder girdle inherited from S43
  • injuries of axilla inherited from S40-S49
  • injuries of scapular region inherited from S40-S49

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Code Also

Additional codes that may be required to fully describe the encounter.

  • any associated open wound

Source: inherited from S43

7th Character Guide

"The appropriate 7th character is to be added to each code from category S43"

  • A — initial encounter
  • D — subsequent encounter
  • S — sequela

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

S43.016A, S43.016D, S43.016S

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for S43.016

MedCoder structured workflow — derived from this code’s own official record

Before you code S43.016

  1. S43.016 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewS43.016A, S43.016D, S43.016S

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. Unspecified does not mean incorrect. When the record gives no greater specificity, S43.016 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewS43.011, S43.012, S43.014, S43.015

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  3. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. S43.016 is not valid without one. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

    See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

  4. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: unspecified). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewS43.014 · right, S43.015 · left

    Guide: Laterality coding →

  5. Confirm the injury type, the anatomical site at the most specific level documented, laterality where the family codes it, and the encounter for the 7th character. Each injury is coded separately unless the classification provides a combination code, and a superficial injury is not coded when a more severe injury of the same site is documented. Injury chapter guidelines (Guidelines I.C.19.b, I.C.19.b.1).

    Guide: 7th characters: initial, subsequent, sequela →

Choose the right path

  1. Does the documentation support one of the more specific codes beneath S43.016?
    Yes → Select that code and continue the checks below on its own page.
    No → S43.016 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewS43.016A, S43.016D, S43.016S

  2. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — S43.016 is appropriate when the documentation goes no further.

    ReviewS43.011, S43.012, S43.014, S43.015

  3. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewS43.014 · right, S43.015 · left

  4. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider S43.016. Then review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Anatomical site
At the most specific level the record states; a site the classification separates cannot be assumed from a procedure or a measurement.
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).
Encounter type
Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).
External cause, place and activity
For the external cause codes reported with the injury or poisoning, where documented (Guidelines I.C.20.a).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of S43.016(5 notes)

    Coding workflow: The conditions named in this note are not included in S43.016. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareS46, T63.4

    See the official tabular notes · Guidelines I.A.12.b

  • Code Also — related condition(1 note)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewS43.011, S43.012, S43.014, S43.015

Documentation: The patient returns during the healing or recovery phase after active treatment of the same condition.

Coding question: Which 7th character applies?

Path: Review the official 7th-character definitions for this family in the 7th Character Guide.

Reason: “Initial encounter” means active treatment, not the first visit; care during recovery takes “subsequent encounter”, and a complication arising from the original condition takes “sequela” (Guidelines I.C.19.a).

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewS43.014 · right, S43.015 · left

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse S43.016 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of S43.016 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • S43.014— Laterality relationship (Review)

    Same condition; these differ only in which side is documented.

    The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

    What moves you there: A documented right side moves the case to S43.014.

    Full comparison: S43.016 vs S43.014 →

  • S43.015— Laterality relationship (Review)

    Same condition; these differ only in which side is documented.

    The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

    What moves you there: A documented left side moves the case to S43.015.

    Full comparison: S43.016 vs S43.015 →

  • S43.016A— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a initial encounter moves the case to S43.016A.

    Full comparison: S43.016 vs S43.016A →

  • S43.016D— Encounter relationship (Review)

    Same underlying diagnosis, different encounter phase.

    The same diagnosis at a different phase of care; one encounter takes one 7th character.

    What moves you there: Documentation of a subsequent encounter moves the case to S43.016D.

    Full comparison: S43.016 vs S43.016D →

  • S46— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of strain of muscle, fascia and tendon of shoulder and upper arm adds S46; it is not part of this code and both may be reported when both are documented.

    Full comparison: S43.016 vs S46 →

  • T20— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of burns and corrosions adds T20; it is not part of this code and both may be reported when both are documented.

    Full comparison: S43.016 vs T20 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Anterior dislocation of unspecified humerus is a non-billable ICD-10-CM category code (S43.016). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. 1 Code Also note — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
  3. 5 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Related Codes

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

S43.014 — Anterior dislocation of right humerus (right)Compare S43.016 vs S43.014 →, S43.015 — Anterior dislocation of left humerus (left)Compare S43.016 vs S43.015 →

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Subluxation”, “Dislocation”; these codes share that main term but sit in a different category of the Tabular List.

S33.120 — Subluxation of L2/L3 lumbar vertebra (vertebral, traumatic, lumbar, joint between, L2 and L3), S33.121 — Dislocation of L2/L3 lumbar vertebra (vertebra, lumbar, joint between, L2 and L3), S33.130 — Subluxation of L3/L4 lumbar vertebra (vertebral, traumatic, lumbar, joint between, L3 and L4), S33.131 — Dislocation of L3/L4 lumbar vertebra (vertebra, lumbar, joint between, L3 and L4), S33.140 — Subluxation of L4/L5 lumbar vertebra (vertebral, traumatic, lumbar, joint between, L4 and L5), S33.141 — Dislocation of L4/L5 lumbar vertebra (vertebra, lumbar, joint between, L4 and L5), S33.2 — Dislocation of sacroiliac and sacrococcygeal joint (sacrum), S33.30 — Dislocation of unspecified parts of lumbar spine and pelvis (pelvis NEC), S33.39 — Dislocation of other parts of lumbar spine and pelvis (innominate), S33.4 — Traumatic rupture of symphysis pubis (symphysis pubis), S53.00 — Unspecified subluxation and dislocation of radial head (radial head), S53.006 — Unspecified dislocation of unspecified radial head (radial head), S53.01 — Anterior subluxation and dislocation of radial head (radial head, anterior), S53.02 — Posterior subluxation and dislocation of radial head (radial head, posterior), S53.03 — Nursemaid's elbow (radial head, nursemaid's elbow), S53.09 — Other subluxation and dislocation of radial head (radial head, specified type NEC), S53.10 — Unspecified subluxation and dislocation of ulnohumeral joint (elbow), S53.11 — Anterior subluxation and dislocation of ulnohumeral joint (elbow, anterior), S53.12 — Posterior subluxation and dislocation of ulnohumeral joint (elbow, posterior), S53.13 — Medial subluxation and dislocation of ulnohumeral joint (elbow, medial), +156 more

Contextual Map

Every relationship of S43.016 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Common coding questions

MedCoder editorial

Can S43.016 be billed directly?

No. S43.016 (Anterior dislocation of unspecified humerus) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does S43.016 require a 7th character?

Yes. The appropriate 7th character is to be added to each code from category S43.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

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

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "S43.016 — Anterior dislocation of unspecified humerus." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/s43.016-anterior-dislocation-of-unspecified-humerus

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Anterior dislocation of unspecified humerus

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S43.016 in its code family, with their registry titles.

View all codes in the S43 family