Is S43.421 a billable ICD-10-CM code?

No. S43.421 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does S43.421 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).

What cannot be coded together with S43.421?

S43.421 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above S43.421 (S43.42) and apply to it just the same.

S43.421

S43.421 — Sprain of right rotator cuff capsule

Non-billable headerICD-10-CMright

S43.421 is a non-billable header ICD-10-CM code for sprain of right 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 inherited from the categories above S43.421

These are not written on S43.421, but they bind it: a note on a category applies to every code beneath it. Billing S43.421 with anything listed here is a denial.

Written on S43.42 — Sprain of rotator cuff capsule

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

Excludes2 inherited from the categories above S43.421

Also inherited, and the opposite of Excludes1: these conditions are not part of S43.421, but a patient can have both, so you may code both.

Written on S43.42 — Sprain of rotator cuff capsule

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

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

S43.421 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 history

S43.421 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead S43.421

3 child codes. Green means billable.

Related codes at this level

Codes that share S43.42. If S43.421 is not quite right, the correct code is usually one of these.

Questions about S43.421

Is S43.421 a billable ICD-10-CM code?: No. S43.421 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does S43.421 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).
What cannot be coded together with S43.421?: S43.421 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above S43.421 (S43.42) and apply to it just the same.