Is S43 a billable ICD-10-CM code?

No. S43 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does S43 sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the shoulder and upper arm (S40-S49).

S43

S43 — Dislocation and sprain of joints and ligaments of shoulder girdle

Non-billable headerICD-10-CM

S43 is a non-billable header ICD-10-CM code for dislocation and sprain of joints and ligaments of shoulder girdle. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

The appropriate 7th character is to be added to each code from category S43

A: initial encounter
D: subsequent encounter
S: sequela

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.

strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)

Code also

Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.

any associated open wound

Includes

Conditions this code covers.

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

Risk adjustment

S43 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead S43

9 child codes. Green means billable.

Questions about S43

Is S43 a billable ICD-10-CM code?: No. S43 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does S43 sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the shoulder and upper arm (S40-S49).