Is S43.422S a billable ICD-10-CM code?

Yes. S43.422S is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S43.422S 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 S43.422S?

S43.422S 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 S43.422S (S43.42) and apply to it just the same.

S43.422S

S43.422S — Sprain of left rotator cuff capsule, sequela

Billable / specific codeICD-10-CMPOA exemptleft

S43.422S is a billable, specific ICD-10-CM code for sprain of left rotator cuff capsule, sequela. It is valid for submission on a claim.

7th character "S" — sequela

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 S43.422S

These are not written on S43.422S, but they bind it: a note on a category applies to every code beneath it. Billing S43.422S 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 S43.422S

Also inherited, and the opposite of Excludes1: these conditions are not part of S43.422S, 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

S43.422S 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

S43.422S is named in 7 Medicare coverage policies — 7 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A53057Billing and Coding: Home Health Occupational Therapy
A53058Billing and Coding: Home Health Physical Therapy
A53064Billing and Coding: Outpatient Occupational Therapy
A53065Billing and Coding: Outpatient Physical Therapy

Code history

S43.422S has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share S43.422. If S43.422S is not quite right, the correct code is usually one of these.

Questions about S43.422S

Is S43.422S a billable ICD-10-CM code?: Yes. S43.422S is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S43.422S 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 S43.422S?: S43.422S 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 S43.422S (S43.42) and apply to it just the same.