Valid for Submission
S43.013A is a billable diagnosis code used to specify a medical diagnosis of anterior subluxation of unspecified humerus, initial encounter. The code S43.013A is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
S43.013A is an initial encounter code, includes a 7th character and should be used while the patient is receiving active treatment for a condition like anterior subluxation of unspecified humerus. According to ICD-10-CM Guidelines an "initial encounter" doesn't necessarily means "initial visit". The 7th character should be used when the patient is undergoing active treatment regardless if new or different providers saw the patient over the course of a treatment. The appropriate 7th character codes should also be used even if the patient delayed seeking treatment for a condition.
Unspecified diagnosis codes like S43.013A are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.
The appropriate 7th character is to be added to each code from block Disloc and sprain of joints and ligaments of shoulder girdle (S43). Use the following options for the aplicable episode of care:
- A - initial encounter
- D - subsequent encounter
- S - sequela
Diagnostic Related Groups - MS-DRG Mapping
|MS-DRG||MS-DRG Title||MCD||Relative Weight|
|562||FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC||08||1.408|
|563||FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC||08||0.8708|
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.
Convert S43.013A to ICD-9 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code S43.013A its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
Information for Patients
What is a 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.
What causes a dislocated shoulder?
Your shoulders are the most movable joints in your body. They are also the most commonly dislocated joints.
The most common causes of shoulder dislocations are
- Sports injuries
- Accidents, including traffic accidents
- Falling on your shoulder or outstretched arm
- Seizures and electric shocks, which can cause muscle contractions that pull the arm out of place
Who is at risk for a dislocated shoulder?
A dislocated shoulder can happen to anyone, but they are more common in young men, who are more often involved in sports and other physical activities. Older adults, especially women, are also at higher risk because they are more likely to fall.
What are the symptoms of a dislocated shoulder?
The symptoms of a dislocated shoulder include
- Severe shoulder pain
- Swelling and bruising of your shoulder or upper arm
- Numbness and/or weakness in your arm, neck, hand, or fingers
- Trouble moving your arm
- Your arm seems to be out of place
- Muscle spasms in your shoulder
If you are having these symptoms, get medical treatment right away.
How is a dislocated shoulder diagnosed?
To make a diagnosis, your health care provider will take a medical history and examine your shoulder. Your provider may also ask you to get an x-ray to confirm the diagnosis.
What are the treatments for a dislocated shoulder?
The treatment for dislocated shoulder usually involves three steps:
- The first step is a closed reduction, a procedure in which your health care provider puts the ball of your upper arm back into the socket. You may first get medicine to relieve the pain and relax your shoulder muscles. Once the joint is back in place, the severe pain should end.
- The second step is wearing a sling or other device to keep your shoulder in place. You will wear it for a few days to several weeks.
- The third step is rehabilitation, once the pain and swelling have improved. You will do exercises to improve your range of motion and strengthen your muscles.
You may need surgery if you injure the tissues or nerves around the shoulder or if you get repeated dislocations.
A dislocation can make your shoulder unstable. When that happens, it takes less force to dislocate it. This means that there is a higher risk of it happening again. Your health care provider may ask you to continue doing some exercises to prevent another dislocation.
[Learn More in MedlinePlus]