S43.42

S43.42: Sprain of rotator cuff capsule

Non-billable headerICD-10-CM

S43.42 is a non-billable header ICD-10-CM code for sprain of rotator cuff capsule. 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

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)

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.

injury of tendon of rotator cuff (S46.0-)

Excludes2 inherited from the categories above S43.42

Not part of this code, but both may be coded when both are present.

Written on S43: Dislocation and sprain of joints and ligaments of shoulder girdle

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

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead S43.42

3 child codes. Green means billable.