Version 2024

2024 ICD-10-CM Diagnosis Code S43.42

Sprain of rotator cuff capsule

ICD-10-CM Code:
S43.42
ICD-10 Code for:
Sprain of rotator cuff capsule
Is Billable?
Not Valid for Submission
Code Navigator:

Code Classification

  • Injury, poisoning and certain other consequences of external causes
    (S00–T88)
    • Injuries to the shoulder and upper arm
      (S40-S49)
      • Dislocation and sprain of joints and ligaments of shoulder girdle
        (S43)

S43.42 is a non-specific and non-billable diagnosis code code, consider using a code with a higher level of specificity for a diagnosis of sprain of rotator cuff capsule. The code is not specific and is NOT valid for the year 2024 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.

Specific Coding Applicable to Sprain of rotator cuff capsule

Non-specific codes like S43.42 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10-CM codes with a higher level of specificity when coding for sprain of rotator cuff capsule:

  • S43.421 for Sprain of right rotator cuff capsule - NON-BILLABLE CODE

  • Use S43.421A for initial encounter - BILLABLE CODE

  • Use S43.421D for subsequent encounter - BILLABLE CODE

  • Use S43.421S for sequela - BILLABLE CODE

  • S43.422 for Sprain of left rotator cuff capsule - NON-BILLABLE CODE

  • Use S43.422A for initial encounter - BILLABLE CODE

  • Use S43.422D for subsequent encounter - BILLABLE CODE

  • Use S43.422S for sequela - BILLABLE CODE

  • S43.429 for Sprain of unspecified rotator cuff capsule - NON-BILLABLE CODE

  • Use S43.429A for initial encounter - BILLABLE CODE

  • Use S43.429D for subsequent encounter - BILLABLE CODE

  • Use S43.429S for sequela - BILLABLE CODE

Coding Guidelines

The appropriate 7th character is to be added to each code from block Dislocation 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

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

Patient Education


Rotator Cuff Injuries

What is a rotator cuff?

Your rotator cuff is part of your shoulder joint. It's a group of muscles and tendons that holds the top part of your upper arm bone firmly in your shoulder socket. The rotator cuff keeps your shoulder stable when you move your arm in any direction.

What are rotator cuff injuries?

Rotator cuff injuries are common. Most of them are wear-and-tear injuries from doing the same arm movements over and over - especially reaching over your head. With time, the tissues in the rotator cuff break down, leading to these injuries:

  • Tendinitis. The tendons in the rotator cuff connect your muscles to your shoulder bones. In tendinitis, the tendons become irritated and swollen from being pinched during shoulder movements.
  • Bursitis. The bursa is a small, fluid-filled sac that pads the space between the rotator cuff and the bones of your shoulder. Bursitis happens when the muscle and bone rub the bursa too much. It swells with extra fluid, which causes pain
  • Rotator cuff tears. Tears in a rotator cuff tendon can happen over time or suddenly from an injury, such as falling on an outstretched arm or lifting something heavy. A tear may go part way through a tendon (partial tear) or all the way through (full tear).

Who is more likely to develop a rotator cuff injury?

Anyone can develop a rotator cuff injury. But certain people are more likely to have one:

  • People over age 40. Most rotator cuff injuries are from the wear and tear of aging. By age 80, most adults have tears.
  • Athletes. Playing sports with repeated shoulder movements increases the risk of a rotator cuff injury, for example, tennis, swimming, and baseball - especially pitching.
  • People in jobs that require a lot of reaching overhead or heavy lifting. Carpenters, construction workers, and painters are examples of workers who may be more likely to have rotator cuff problems.

What are the symptoms of rotator cuff injuries?

Rotator cuff injuries don't always cause pain. But when they do, the pain is often in the top part of your arm or shoulder. You may feel more pain when you:

  • Lie down, especially on the injured shoulder
  • Lift your arm or lower it to the front or side
  • Reach behind your back

Other symptoms from a torn rotator cuff may include:

  • Loss of strength in the arm
  • Clicking or popping sounds when you move your arm

How are rotator cuff injuries diagnosed?

To find out if you have a rotator cuff injury, your health care provider:

  • Will examine your shoulder. This includes checking the range of motion and where the pain is.
  • Will test your arm and shoulder strength.
  • May order imaging tests, such as x-rays, an ultrasound, or an MRI scan.

What are the treatments for rotator cuff injuries?

The best treatment for you depends on your age, how much your injury bothers you, and whether your injury was sudden or happened from wear and tear.

Treatments for rotator cuff injuries often include:

  • Rest
  • Putting ice or a cold pack on the sore area
  • Pain relievers to lessen pain and swelling, such as ibuprofen or aspirin
  • Physical therapy exercises to strengthen your shoulder and improve movement
  • A corticosteroid shot into your shoulder joint if other treatments don't help with the pain

Treatments for rotator cuff tendinitis and bursitis may also include ultrasound therapy. Surgery may be an option if your shoulder doesn't feel better in 6 to 12 months.

Treatments for a torn rotator cuff may also include heat to the sore area or electrical stimulation of the nerves and muscles (transcutaneous electrical nerve stimulation, TENS).

You provider may suggest surgery if your tear is large or is from a recent injury, or symptoms last for 6 to 12 months.

When should I see a health care provider for shoulder pain?

If certain activities bother your shoulder, it's best to stop doing them and check with your provider. That's because early treatment can prevent mild rotator cuff injuries from becoming more serious later on. If you your arm feels weak right after a sudden injury to your shoulder, see your provider as soon as possible.


[Learn More in MedlinePlus]

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.

A strain is a stretched or torn muscle or tendon. Tendons are tissues that connect muscle to bone. Twisting or pulling these tissues can cause a strain. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common. Many people get strains playing sports. Symptoms include pain, muscle spasms, swelling, and trouble moving the muscle.

At first, treatment of both sprains and strains usually involves resting the injured area, icing it, wearing a bandage or device that compresses the area, and medicines. Later treatment might include exercise and physical therapy.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases


[Learn More in MedlinePlus]

Code History

  • FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
  • FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
  • FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.