2026 ICD-10-CM Diagnosis Code S43.402SUnspecified sprain of left shoulder joint, sequela
S43.402S is a billable ICD-10-CM diagnosis code for unspecified sprain of left shoulder joint, sequela. The 7th character S marks it as a sequela code, which reports a problem that remains after the original condition has resolved. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 562 through 563. The code is exempt from POA reporting. Coders also document this condition as disorder of ligament of left shoulder joint. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Injury, sequela.
Code Identity
Code Classification
Present on Admission (POA)Billing
S43.402S is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Disorder of ligament of left shoulder joint
- Disorder of ligament of left shoulder region
- Rupture of ligament of left shoulder joint
- Rupture of shoulder ligament
- Sprain of ligament of left shoulder joint
- Sprain of shoulder
Coding GuidelinesGuidance
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 applicable episode of care:
- A - initial encounter
- D - subsequent encounter
- S - sequela
Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, published by CMS and the National Center for Health Statistics.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Shoulder Injuries and Disorders
Your shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). Your shoulders are the most movable joints in your body. They can also be unstable because the ball of the upper arm is larger than the shoulder socket that holds it.
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Convert S43.402S to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S43.402SOverview
Is S43.402S (Unspecified sprain of left shoulder joint) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report unspecified sprain of left shoulder joint, sequela on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character S in S43.402S mean?
The final character S makes this a sequela code: it reports a lingering problem that remains after the unspecified sprain of left shoulder joint itself has resolved, not the original event.
What MS-DRG does S43.402S group to?
When unspecified sprain of left shoulder joint, sequela is the principal diagnosis on an inpatient stay, it groups to MS-DRG 562, 563, with relative weights from 0.8955 to 1.4248 depending on complications. Higher weights mean higher Medicare reimbursement.
Is S43.402S exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for unspecified sprain of left shoulder joint, sequela on inpatient claims.
What is the ICD-9 equivalent of S43.402S?
Under the General Equivalence Mappings, unspecified sprain of left shoulder joint, sequela converts to ICD-9-CM 905.7 (late effec sprain/strain). The mapping is approximate, so confirm the match fits the documentation.
Footnotes
[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.
