Non-Billable / Non-Specific Code
ICD-10-CM S43.42 is the diagnosis code for Sprain of rotator cuff capsule. This code falls under the section "Injuries to the shoulder and upper arm" within Chapter 19 â Injury, poisoning and certain other consequences of external causes (S00-T88). It is a non-billable/non-specific ICD-10-CM code that should not be used for reimbursement. A more specific sub-code is required for billing. Medical coders and healthcare providers use this code to document and classify diagnoses in electronic health records, insurance claims, and clinical databases.
The following conditions should never be coded at the same time as S43.42. They are mutually exclusive:
The following conditions are not included in S43.42. If the patient has both, code each condition separately:
Understanding where S43.42 sits in the ICD-10-CM classification helps ensure proper coding:
No, S43.42 is a non-billable/non-specific code. You should use a more specific sub-code for billing and reimbursement.
S43.42 is the ICD-10-CM diagnosis code for "Sprain of rotator cuff capsule". It is used by healthcare providers to classify and document this condition in medical records and insurance claims.
The parent code of S43.42 is S43.4 ("Sprain of shoulder joint"). S43.42 provides a more specific classification within this category.
S43.42 is located in Section S40-S49 â "Injuries to the shoulder and upper arm" within Chapter 19 of the ICD-10-CM Tabular List.
S43.42 has 3 sub-code(s) that provide more specific detail: S43.421, S43.422, S43.429.
Use S43.42 when the patients documented diagnosis matches "Sprain of rotator cuff capsule" and the clinical documentation supports this level of specificity. Always verify with the latest ICD-10-CM guidelines and payer requirements.
The ICD-10-CM code for Sprain of rotator cuff capsule is S43.42.
No, S43.42 is non-billable. Use a more specific sub-code for primary diagnosis billing.
S43.42 is in Chapter 19 of the ICD-10-CM Tabular List.
Type 1 Excludes for S43.42 include: rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-).
Yes, S43.42 is a valid ICD-10-CM code for the 2026 fiscal year, subject to official CMS updates.