Skip to main content

S43.61XA ICD-10-CM Code: Sprain of right sternoclavicular joint, initial encounter

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 562 — FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC (MDC 08)
  • MS-DRG 563 — FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC (MDC 08)
  • MS-DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)
  • MS-DRG 964 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC (MDC 24)
  • MS-DRG 965 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC (MDC 24)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Official Registry Overview & Definition

Sprain of right sternoclavicular joint, initial encounter is a billable ICD-10-CM diagnosis code (S43.61A).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for S43.61XA 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

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 S43.61XA 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

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 S43.61XA 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]
  • S40-S49 — Injuries to the shoulder and upper arm [Hierarchy]

Clinical classification (CCSR)

  • INJ024 — Sprains and strains, initial encounter [CCSR]

Potential MS-DRG

  • DRG 562 — FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC [MS-DRG]: “FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC (MDC 08)”
  • DRG 563 — FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC [MS-DRG]: “FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC (MDC 08)”
  • DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC [MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)”
  • DRG 964 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC [MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC (MDC 24)”
  • DRG 965 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC [MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC (MDC 24)”

MDC crossing · procedures (41465)

  • MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue [MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • MDC 24 — Multiple Significant Trauma [MDC crossing]: “Multiple Significant Trauma — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 005T0ZZ — Destruction of Spinal Meninges, Open Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T3ZZ — Destruction of Spinal Meninges, Percutaneous Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005T4ZZ — Destruction of Spinal Meninges, Percutaneous Endoscopic Approach [Same-MDC procedure]: “Destruction of Spinal Meninges, Percutaneous Endoscopic Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0Z3 — Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord using Laser Interstitial Thermal Therapy, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • 005W0ZZ — Destruction of Cervical Spinal Cord, Open Approach [Same-MDC procedure]: “Destruction of Cervical Spinal Cord, Open Approach — grouped in MDC 08, the procedure side of this code's crossing.” · check together
  • and 41460 more

Nearest codes (40)

  • S43 — Dislocation and sprain of joints and ligaments of shoulder girdle [Sibling]
  • S43.499S — Other sprain of unspecified shoulder joint, sequela [Sibling]
  • S43.5 — Sprain of acromioclavicular joint [Sibling]
  • S43.50 — Sprain of unspecified acromioclavicular joint [Sibling]
  • S43.50XA — Sprain of unspecified acromioclavicular joint, initial encounter [Sibling]
  • S43.50XD — Sprain of unspecified acromioclavicular joint, subsequent encounter [Sibling]
  • S43.50XS — Sprain of unspecified acromioclavicular joint, sequela [Sibling]
  • S43.51 — Sprain of right acromioclavicular joint [Sibling]
  • and 32 more

Relationships & Classification

Clinical classification (AHRQ CCSR):INJ024 — Sprains and strains, initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 5 MS-DRGs: DRG 562 (MDC 08), DRG 563 (MDC 08), DRG 963 (MDC 24), DRG 964 (MDC 24), DRG 965 (MDC 24).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Frequently Asked Questions (FAQ) & Clinical Guidance

Does S43.61XA 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 S43.61XA in its code family, with their registry titles.

  • S43.60 — Sprain of unspecified sternoclavicular joint
  • S43.60XA — Sprain of unspecified sternoclavicular joint, initial encounter
  • S43.60XD — Sprain of unspecified sternoclavicular joint, subsequent encounter
  • S43.60XS — Sprain of unspecified sternoclavicular joint, sequela
  • S43.61 — Sprain of right sternoclavicular joint
  • S43.61XD — Sprain of right sternoclavicular joint, subsequent encounter
  • S43.61XS — Sprain of right sternoclavicular joint, sequela
  • S43.62 — Sprain of left sternoclavicular joint
  • S43.62XA — Sprain of left sternoclavicular joint, initial encounter
  • S43.62XD — Sprain of left sternoclavicular joint, subsequent encounter

View all codes in the S43 family