2026 ICD-10-CM Diagnosis Code S43.419DSprain of unspecified coracohumeral (ligament), subsequent encounter
S43.419D is a billable ICD-10-CM diagnosis code for sprain of unspecified coracohumeral (ligament), 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 coracohumeral sprain. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sprains and strains, subsequent encounter.
Code Identity
Code Classification
Present on Admission (POA)Billing
S43.419D 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.
- Coracohumeral sprain
- 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.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert S43.419D to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S43.419DOverview
Is S43.419D (Sprain of unspecified coracohumeral (ligament)) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report sprain of unspecified coracohumeral (ligament), subsequent encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character D in S43.419D mean?
The final character D marks a subsequent encounter: use it for routine care while the sprain of unspecified coracohumeral (ligament) is healing, after active treatment has ended.
What MS-DRG does S43.419D group to?
When sprain of unspecified coracohumeral (ligament), 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 S43.419D 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 sprain of unspecified coracohumeral (ligament), subsequent encounter on inpatient claims.
What is the ICD-9 equivalent of S43.419D?
Under the General Equivalence Mappings, sprain of unspecified coracohumeral (ligament), 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.
