S43.42 — Sprain of rotator cuff capsule
Is S43.42 billable?
No — S43.42 is a non-billable header code. S43.42 groups more specific codes and cannot be submitted on a claim. A valid ICD-10-CM code must be reported at the highest level of specificity available in its branch. Select one of the 9 billable codes beneath S43.42.
Billable codes under this header
- S43.421ASprain of right rotator cuff capsule, initial encounter
- S43.421DSprain of right rotator cuff capsule, subsequent encounter
- S43.421SSprain of right rotator cuff capsule, sequela
- S43.422ASprain of left rotator cuff capsule, initial encounter
- S43.422DSprain of left rotator cuff capsule, subsequent encounter
- S43.422SSprain of left rotator cuff capsule, sequela
- S43.429ASprain of unspecified rotator cuff capsule, initial encounter
- S43.429DSprain of unspecified rotator cuff capsule, subsequent encounter
- S43.429SSprain of unspecified rotator cuff capsule, sequela
S43.42 at a glance
| Code | S43.42 |
|---|---|
| Description | Sprain of rotator cuff capsule |
| Billable | No — header code |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
How is S43.42 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to S43.42. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Sprain › rotator cuff (joint) (ligament)
- Tear, torn › rotator cuff › traumatic › capsule (traumatic)
Excludes1 — never code together
The conditions below can never be reported together with S43.42 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)
Excludes2 — not included here
The conditions below are not part of S43.42, but a patient may have both at the same time. When documentation supports it, S43.42 and the excluded code may both be reported.
- injury of tendon of rotator cuff (S46.0-)
Use additional code — inherited from Chapter 19
Report an additional code alongside S43.42 to fully describe the condition. S43.42 is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of S43.42, but a patient may have both at the same time. When documentation supports it, S43.42 and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S43.42, but a patient may have both at the same time. When documentation supports it, S43.42 and the excluded code may both be reported.
Excludes2 — not included here — inherited from S43
The conditions below are not part of S43.42, but a patient may have both at the same time. When documentation supports it, S43.42 and the excluded code may both be reported.
- strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)
Code also — inherited from S43
Two codes may be needed to describe the condition fully. Whether S43.42 is sequenced first depends on the reason for the encounter.
- any associated open wound
What codes fall under S43.42? (3)
How long has S43.42 existed?
S43.42 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.