S43.419A
S43.419A — Sprain of unspecified coracohumeral (ligament), initial encounter
Billable / specific codeICD-10-CM
S43.419A is a billable, specific ICD-10-CM code for sprain of unspecified coracohumeral (ligament), initial encounter. It is valid for submission on a claim.
7th character "A" — initial encounter
The appropriate 7th character is to be added to each code from category S43
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Risk adjustment
S43.419A 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.
Medicare coverage
S43.419A is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53065Billing and Coding: Outpatient Physical Therapy
Related codes at this level
Codes that share S43.419. If S43.419A is not quite right, the correct code is usually one of these.
Questions about S43.419A
- Is S43.419A a billable ICD-10-CM code?
- Yes. S43.419A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S43.419A 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).