S43.81 ICD-10-CM Code: Sprain of other specified parts of right shoulder girdle
Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.
Official Registry Overview & Definition
Official Tabular Instructional Notes
Sequencing, inclusion, and exclusion notes published for S43.81 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.
- strain of muscle, fascia and tendon of shoulder and upper arm (S46.-) Compare S43.81 vs S46 →
- burns and corrosions (T20-T32) Compare S43.81 vs T20 →
- frostbite (T33-T34) Compare S43.81 vs T33 →
- injuries of elbow (S50-S59) Compare S43.81 vs S50 →
- insect bite or sting, venomous (T63.4) Compare S43.81 vs T63.4 →
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 S43.81 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
- Not billable as written — a more specific code is required: S43.81XA, S43.81XD, S43.81XS.
- Requires a 7th character. "The appropriate 7th character is to be added to each code from category S43" Options: S43.81XA, S43.81XD, S43.81XS
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 S43.81 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]
Nearest codes (40)
- S43 — Dislocation and sprain of joints and ligaments of shoulder girdle [Sibling]
- S43.52XD — Sprain of left acromioclavicular joint, subsequent encounter [Sibling]
- S43.52XS — Sprain of left acromioclavicular joint, sequela [Sibling]
- S43.6 — Sprain of sternoclavicular joint [Sibling]
- S43.60 — Sprain of unspecified sternoclavicular joint [Sibling]
- S43.60XA — Sprain of unspecified sternoclavicular joint, initial encounter [Sibling]
- S43.60XD — Sprain of unspecified sternoclavicular joint, subsequent encounter [Sibling]
- S43.60XS — Sprain of unspecified sternoclavicular joint, sequela [Sibling]
- and 32 more
Frequently Asked Questions (FAQ) & Clinical Guidance
Can S43.81 be billed directly?
No. S43.81 (Sprain of other specified parts of right shoulder girdle) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.
Does S43.81 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 S43.81 in its code family, with their registry titles.
- S43.8 — Sprain of other specified parts of shoulder girdle
- S43.80 — Sprain of other specified parts of unspecified shoulder girdle
- S43.80XA — Sprain of other specified parts of unspecified shoulder girdle, initial encounter
- S43.80XD — Sprain of other specified parts of unspecified shoulder girdle, subsequent encounter
- S43.80XS — Sprain of other specified parts of unspecified shoulder girdle, sequela
- S43.81XA — Sprain of other specified parts of right shoulder girdle, initial encounter
- S43.81XD — Sprain of other specified parts of right shoulder girdle, subsequent encounter
- S43.81XS — Sprain of other specified parts of right shoulder girdle, sequela
- S43.82 — Sprain of other specified parts of left shoulder girdle
- S43.82XA — Sprain of other specified parts of left shoulder girdle, initial encounter