S43.499A — Other sprain of unspecified shoulder joint, initial encounter
Is S43.499A billable?
Yes, but S43.499A is an unspecified code. S43.499A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, S43.499A is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting S43.499A — the more specific alternatives are listed below.
S43.499A at a glance
| Code | S43.499A |
|---|---|
| Description | Other sprain of unspecified shoulder joint, 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 S43.499A?
In S43.499A, the 7th character A means initial encounter. The 7th character is required for S43.499A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
Which MS-DRGs does S43.499A group to?
S43.499A 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 S43.499A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S43.49, the nearest indexed parent of S43.499A. Use them to find the family, then select the specific code.
- Degeneration, degenerative › anterior labral
- Sprain › shoulder joint › specified site NEC (joint) (ligament)
Use additional code — inherited from Chapter 19
Report an additional code alongside S43.499A to fully describe the condition. S43.499A 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 S43.499A, but a patient may have both at the same time. When documentation supports it, S43.499A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S43.499A, but a patient may have both at the same time. When documentation supports it, S43.499A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S43
The conditions below are not part of S43.499A, but a patient may have both at the same time. When documentation supports it, S43.499A 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 S43.499A is sequenced first depends on the reason for the encounter.
- any associated open wound
How long has S43.499A existed?
S43.499A 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.