S40-S49 — Injuries to the shoulder and upper arm
ICD-10-CM codes S40-S49 cover injuries to the shoulder and upper arm, within injury, poisoning and certain other consequences of external causes. The block holds 3,546 codes across 10 categories, of which 2,730 are billable and 816 are header codes that cannot be submitted on a claim. 3,546 of them (100%) require a 7th character.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
Includes
Conditions this code covers.
- injuries of axilla
- injuries of scapular region
The 7th character in S40-S49
A code in this block is not complete without its 7th character, and a missing one is a rejected claim rather than a denied one: the clearinghouse never passes it on. 3,546 of the 3,546 codes here take one.
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Risk adjustment in S40-S49
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 405 Traumatic Amputations and Complications
What else to watch in S40-S49
- 2,226 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 2,223 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in S40-S49
- S40Superficial injury of shoulder and upper arm
- S41Open wound of shoulder and upper arm
- S42Fracture of shoulder and upper arm
- S43Dislocation and sprain of joints and ligaments of shoulder girdle
- S44Injury of nerves at shoulder and upper arm level
- S45Injury of blood vessels at shoulder and upper arm level
- S46Injury of muscle, fascia and tendon at shoulder and upper arm level
- S47Crushing injury of shoulder and upper arm
- S48Traumatic amputation of shoulder and upper arm
- S49Other and unspecified injuries of shoulder and upper arm