Skip to main content

S43.42 ICD-10-CM Code: Sprain of rotator cuff capsule

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Official Registry Overview & Definition

Sprain of rotator cuff capsule is a non-billable ICD-10-CM category code (S43.42). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for S43.42 in the official ICD-10-CM tabular list.

Includes

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

  • 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
  • injuries of axilla
  • injuries of scapular region

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

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

Frequently Compared Codes

The official Excludes notes on S43.42 name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

No changes recorded for this code — unchanged since the FY2016 baseline of the change ledger.

Verify Before Coding

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

Contextual Map

Every relationship of S43.42 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

  • S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88) [Hierarchy]

Excludes1

  • M75.1 — Rotator cuff tear or rupture, not specified as traumatic [Excludes1]: “rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)” · check together

Excludes2

  • S46.0 — Injury of muscle(s) and tendon(s) of the rotator cuff of shoulder [Excludes2]: “injury of tendon of rotator cuff (S46.0-)” · check together

Nearest codes (40)

  • S43 — Dislocation and sprain of joints and ligaments of shoulder girdle [Sibling]
  • S43.402A — Unspecified sprain of left shoulder joint, initial encounter [Sibling]
  • S43.402D — Unspecified sprain of left shoulder joint, subsequent encounter [Sibling]
  • S43.402S — Unspecified sprain of left shoulder joint, sequela [Sibling]
  • S43.409 — Unspecified sprain of unspecified shoulder joint [Sibling]
  • S43.409A — Unspecified sprain of unspecified shoulder joint, initial encounter [Sibling]
  • S43.409D — Unspecified sprain of unspecified shoulder joint, subsequent encounter [Sibling]
  • S43.409S — Unspecified sprain of unspecified shoulder joint, sequela [Sibling]
  • and 32 more

Frequently Asked Questions (FAQ) & Clinical Guidance

Can S43.42 be billed directly?

No. S43.42 (Sprain of rotator cuff capsule) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does S43.42 require a 7th character?

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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S43.42 in its code family, with their registry titles.

  • S43.412S — Sprain of left coracohumeral (ligament), sequela
  • S43.419 — Sprain of unspecified coracohumeral (ligament)
  • S43.419A — Sprain of unspecified coracohumeral (ligament), initial encounter
  • S43.419D — Sprain of unspecified coracohumeral (ligament), subsequent encounter
  • S43.419S — Sprain of unspecified coracohumeral (ligament), sequela
  • S43.421 — Sprain of right rotator cuff capsule
  • S43.421A — Sprain of right rotator cuff capsule, initial encounter
  • S43.421D — Sprain of right rotator cuff capsule, subsequent encounter
  • S43.421S — Sprain of right rotator cuff capsule, sequela
  • S43.422 — Sprain of left rotator cuff capsule

View all codes in the S43 family