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S49.91XD ICD-10-CM Code: Unspecified injury of right shoulder and upper arm, subsequent 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.

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, subsequent encounter is a billable ICD-10-CM diagnosis code (S49.91D).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for S49.91XD 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.

Frequently Compared Codes

The official Excludes notes on S49.91XD 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.

Relationships & Classification

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 2 MS-DRGs: DRG 949 (MDC 23), DRG 950 (MDC 23).

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

Clinical classification (AHRQ CCSR):INJ064 — Other unspecified injuries, subsequent encounter (default).

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

Contextual Map

Every relationship of S49.91XD 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)

  • INJ064 — Other unspecified injuries, subsequent encounter [CCSR]

Potential MS-DRG

  • DRG 949 — AFTERCARE WITH CC/MCC [MS-DRG]: “AFTERCARE WITH CC/MCC (MDC 23)”
  • DRG 950 — AFTERCARE WITHOUT CC/MCC [MS-DRG]: “AFTERCARE WITHOUT CC/MCC (MDC 23)”

MDC crossing · procedures (1235)

  • MDC 23 — Factors Influencing Health Status and Other Contacts with Health Services [MDC crossing]: “Factors Influencing Health Status and Other Contacts with Health Services — 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.”
  • F003GKZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Audiovisual Equipment [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Audiovisual Equipment — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GMZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Augmentative / Alternative Communication Equipment [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Augmentative / Alternative Communication Equipment — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GPZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Computer [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Computer — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GYZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Other Equipment [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body using Other Equipment — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • F003GZZ — Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body [Same-MDC procedure]: “Communicative/Cognitive Integration Skills Assessment of Neurological System - Whole Body — grouped in MDC 23, the procedure side of this code's crossing.” · check together
  • and 1230 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

Frequently Asked Questions (FAQ) & Clinical Guidance

Does S49.91XD 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 S49.91XD 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
  • S49.91XA — Unspecified injury of right shoulder and upper arm, initial 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