Is ICD-10-CM code S43 billable?

No, S43 (Dislocation and sprain of joints and ligaments of shoulder girdle) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code S43 belong to?

S43 belongs to Chapter 19 of the ICD-10-CM tabular list: S00–T88 (Injury, Poisoning and Certain Other Consequences of External Causes).

S43Not billable, use a more specific code below

Dislocation and sprain of joints and ligaments of shoulder girdle

In Injuries to the shoulder and upper arm (S40-S49), chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes

333 billable codes under S43: 18 are a CC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.

Instructional notes

Includes: conditions that are coded here

avulsion of joint or ligament of shoulder girdle
laceration of cartilage, joint or ligament of shoulder girdle
sprain of cartilage, joint or ligament of shoulder girdle
traumatic hemarthrosis of joint or ligament of shoulder girdle
traumatic rupture of joint or ligament of shoulder girdle
traumatic subluxation of joint or ligament of shoulder girdle
traumatic tear of joint or ligament of shoulder girdle

Excludes2: not included here, code separately if applicable

strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)

Code also: add a code for this too, order depends on the encounter

any associated open wound

Also applies, from Injuries to the shoulder and upper arm (S40-S49)

These notes sit on S40-S49 and apply to every code under it, including S43.

Includes: conditions that are coded here

injuries of axilla
injuries of scapular region

Excludes2: not included here, code separately if applicable

burns and corrosions (T20-T32)
frostbite (T33-T34)
injuries of elbow (S50-S59)
insect bite or sting, venomous (T63.4)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers 7th character use and coding of injuries, fractures, burns, drug and toxic effects, abuse and neglect, and complications of care (S00-T88).

Application of 7th Characters in Chapter 19 (page 77)
Coding of Injuries (page 78)
Coding of Traumatic Fractures (page 79)
Coding of Burns and Corrosions (page 80)
Adverse Effects, Poisoning, Underdosing and Toxic Effects (page 82)
Adult and child abuse, neglect and other maltreatment (page 85)
Complications of care (page 85)

Read Section I.C.19 (page 77)

All codes under S43

S43 can't be used on a claim. Pick a billable code below; grey headings group them.

S43 MS-DRGs

As the principal diagnosis, the billable codes under S43 group to these 10 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 562 Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh with MCC (204 of 333 codes)
DRG 563 Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh without MCC (204 of 333 codes)
DRG 949 Aftercare with CC/MCC (111 of 333 codes)
DRG 950 Aftercare without CC/MCC (111 of 333 codes)
DRG 963 Other Multiple Significant Trauma with MCC (111 of 333 codes)
DRG 964 Other Multiple Significant Trauma with CC (111 of 333 codes)
DRG 965 Other Multiple Significant Trauma without CC/MCC (111 of 333 codes)
DRG 183 Major Chest Trauma with MCC (18 of 333 codes)
DRG 184 Major Chest Trauma with CC (18 of 333 codes)
DRG 185 Major Chest Trauma without CC/MCC (18 of 333 codes)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Dislocated Shoulder

Your shoulder joint is made up of three bones: your collarbone, your shoulder blade, and your upper arm bone. The top of your upper arm bone is shaped like a ball. This ball fits into a cuplike socket in your shoulder blade. A shoulder dislocation is an injury that happens when the ball pops out of your socket. A dislocation may be partial, where the ball is only partially out of the socket. It can also be a full dislocation, where the ball is completely out of the socket.

Sprains and Strains

A sprain is a stretched or torn ligament. Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting hit can all cause a sprain. Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising, and being unable to move your joint. You might feel a pop or tear when the injury happens.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.