S43.42
Header — not billableSprain of rotator cuff capsule
The ICD-10 code for sprain of rotator cuff capsule is S43.42.
S43.42 is a non-billable header code. It groups related conditions but cannot be used on its own for reimbursement — select one of the 3 more specific codes below.
Clinical notes
Excludes1 (not coded here)
An Excludes1 note is a pure exclusion: the excluded condition and this code should never be reported together, because the two conditions cannot occur at the same time (e.g. a congenital form vs. an acquired form of the same disease).
- rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)
Excludes2 (not included here)
An Excludes2 note means the excluded condition is not part of this one, but a patient can have both at the same time — in that case both codes may be reported together.
- injury of tendon of rotator cuff (S46.0-)
Documentation support
General coding-documentation guidance — not a substitute for payer-specific requirements or professional coding judgment.
- •This is a non-billable header code. Documentation must support a more specific child code before this diagnosis can be reported on a claim.
- •Confirm the excluded condition(s) listed above are not also present — Excludes1 conditions cannot be coded together with this one.
- •As a general rule, code to the highest level of specificity supported by the documentation in the medical record.