S43.421A — Sprain of right rotator cuff capsule, initial encounter
Is S43.421A billable?
Yes — S43.421A is billable for FY2027. S43.421A is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. S43.421A may be submitted for encounters from October 1, 2026 through September 30, 2027.
S43.421A at a glance
| Code | S43.421A |
|---|---|
| Description | Sprain of right rotator cuff capsule, initial encounter |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter |
What does the 7th character "A" mean in S43.421A?
In S43.421A, the 7th character A means initial encounter. The 7th character is required for S43.421A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
Which MS-DRGs does S43.421A group to?
S43.421A sits in MDC 08 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 562Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh with MCCmedical
- 563Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh without MCCmedical
How is S43.421A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S43.42, the nearest indexed parent of S43.421A. Use them to find the family, then select the specific code.
- Sprain › rotator cuff (joint) (ligament)
- Tear, torn › rotator cuff › traumatic › capsule (traumatic)
Excludes1 — never code together — inherited from S43.42
The conditions below can never be reported together with S43.421A 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-)
Use additional code — inherited from Chapter 19
Report an additional code alongside S43.421A to fully describe the condition. S43.421A 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 S43.421A, but a patient may have both at the same time. When documentation supports it, S43.421A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S43.421A, but a patient may have both at the same time. When documentation supports it, S43.421A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S43
The conditions below are not part of S43.421A, but a patient may have both at the same time. When documentation supports it, S43.421A and the excluded code may both be reported.
- strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)
Excludes2 — not included here — inherited from S43.42
The conditions below are not part of S43.421A, but a patient may have both at the same time. When documentation supports it, S43.421A and the excluded code may both be reported.
- injury of tendon of rotator cuff (S46.0-)
Code also — inherited from S43
Two codes may be needed to describe the condition fully. Whether S43.421A is sequenced first depends on the reason for the encounter.
- any associated open wound
How long has S43.421A existed?
S43.421A 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.