2026 ICD-10-CM Diagnosis Code S43.409DUnspecified sprain of unspecified shoulder joint, subsequent encounter

ICD-10-CM Codes›S00–T88›S40-S49›S43

ICD-10-CM S43.409D
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

S43.409D is a billable ICD-10-CM diagnosis code for unspecified sprain of unspecified shoulder joint, subsequent encounter. The 7th character D marks it as a subsequent encounter code, used during routine care in the healing or recovery phase. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 949 through 950. The code is exempt from POA reporting. Coders also document this condition as complete tear of shoulder joint. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sprains and strains, subsequent encounter.

Code Identity

ICD-10-CM Code
S43.409D
Billable Status
Yes — Valid for Submission
Code Describes
Unspecified sprain of unspecified shoulder joint, subsequent encounter
Short Description
Unsp sprain of unspecified shoulder joint, subs encntr
Parent Code
S43.409
Unspecified sprain of unspecified shoulder joint

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionS40-S49Injuries to the shoulder and upper arm
CategoryS43Dislocation and sprain of joints and ligaments of shoulder girdle
This CodeS43.409DUnspecified sprain of unspecified shoulder joint, subsequent encounter

Present on Admission (POA)Billing

S43.409D 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.

  • Complete tear of shoulder joint
  • Rupture of shoulder ligament
  • 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.

CCSR INJ061
Sprains and strains, subsequent encounter
Default principal diagnosis: inpatient Yes · outpatient Yes

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.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert S43.409D to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
V58.89 Other specfied aftercare
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About S43.409DOverview

Is S43.409D (Unspecified sprain of unspecified shoulder joint) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report unspecified sprain of unspecified shoulder joint, subsequent encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character D in S43.409D mean?

The final character D marks a subsequent encounter: use it for routine care while the unspecified sprain of unspecified shoulder joint is healing, after active treatment has ended.

What MS-DRG does S43.409D group to?

When unspecified sprain of unspecified shoulder joint, subsequent encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 949, 950, with relative weights from 0.6277 to 1.1897 depending on complications. Higher weights mean higher Medicare reimbursement.

Is S43.409D 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 unspecified shoulder joint, subsequent encounter on inpatient claims.

What is the ICD-9 equivalent of S43.409D?

Under the General Equivalence Mappings, unspecified sprain of unspecified shoulder joint, subsequent encounter converts to ICD-9-CM V58.89 (other specfied aftercare). 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.