S46

S46: Injury of muscle, fascia and tendon at shoulder and upper arm level

Non-billable headerICD-10-CM

S46 is a non-billable header ICD-10-CM code for injury of muscle, fascia and tendon at shoulder and upper arm level. 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 S46

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.

injury of muscle, fascia and tendon at elbow (S56.-)
sprain of joints and ligaments of shoulder girdle (S43.9)

Code also

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

any associated open wound (S41.-)

Other codes that can never be billed with S46

Their own Excludes1 notes name this code, so the conflict is not listed above.

M75.1Rotator cuff tear or rupture, not specified as traumatic

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 S46

6 child codes. Green means billable.