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ICD-10/S49.91XA

S49.91XA ICD-10-CM Code: Unspecified injury of right shoulder and upper arm, 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 913 — TRAUMATIC INJURY WITH MCC (MDC 21)
  • MS-DRG 914 — TRAUMATIC INJURY WITHOUT MCC (MDC 21)
  • 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

Unspecified injury of right shoulder and upper arm, initial encounter is a billable ICD-10-CM diagnosis code (S49.91A).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for S49.91XA in the official ICD-10-CM tabular list.

Includes

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

  • 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.

Change history

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

Verify Before Coding

  • Billable — reportable as written.

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 S49.91XA 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)

  • INJ027 — Other unspecified injury [CCSR]

Potential MS-DRG

  • DRG 913 — TRAUMATIC INJURY WITH MCC [MS-DRG]: “TRAUMATIC INJURY WITH MCC (MDC 21)”
  • DRG 914 — TRAUMATIC INJURY WITHOUT MCC [MS-DRG]: “TRAUMATIC INJURY WITHOUT MCC (MDC 21)”
  • 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 (54986)

  • MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs [MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — 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.”
  • 0016070 — Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016071 — Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016072 — Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016073 — Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016074 — Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • and 54981 more

Nearest codes (40)

  • S49 — Other and unspecified injuries of shoulder and upper arm [Sibling]
  • S49.191S — Other physeal fracture of lower end of humerus, right arm, sequela [Sibling]
  • S49.192 — Other physeal fracture of lower end of humerus, left arm [Sibling]
  • S49.192A — Other physeal fracture of lower end of humerus, left arm, initial encounter for closed fracture [Sibling]
  • S49.192D — Other physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with routine healing [Sibling]
  • S49.192G — Other physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with delayed healing [Sibling]
  • S49.192K — Other physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with nonunion [Sibling]
  • S49.192P — Other physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with malunion [Sibling]
  • and 32 more

Relationships & Classification

Clinical classification (AHRQ CCSR):INJ027 — Other unspecified injury (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 913 (MDC 21), DRG 914 (MDC 21), 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 S49.91XA require a 7th character?

Yes. The appropriate 7th character is to be added to each code in subcategory S49.9; The appropriate 7th character is to be added to each code from subcategories S49.0 and S49.1.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S49.91XA in its code family, with their registry titles.

  • S49.90 — Unspecified injury of shoulder and upper arm, unspecified arm
  • S49.90XA — Unspecified injury of shoulder and upper arm, unspecified arm, initial encounter
  • S49.90XD — Unspecified injury of shoulder and upper arm, unspecified arm, subsequent encounter
  • S49.90XS — Unspecified injury of shoulder and upper arm, unspecified arm, sequela
  • S49.91 — Unspecified injury of right shoulder and upper arm
  • S49.91XD — Unspecified injury of right shoulder and upper arm, subsequent encounter
  • S49.91XS — Unspecified injury of right shoulder and upper arm, sequela
  • S49.92 — Unspecified injury of left shoulder and upper arm
  • S49.92XA — Unspecified injury of left shoulder and upper arm, initial encounter
  • S49.92XD — Unspecified injury of left shoulder and upper arm, subsequent encounter

View all codes in the S49 family