2027 ICD-10-CM Diagnosis Code S43.421SSprain of right rotator cuff capsule, sequela

ICD-10-CM Codes›S00–T88›S40-S49›S43

ICD-10-CM S43.421S
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

S43.421S is a billable ICD-10-CM diagnosis code for sprain of right rotator cuff capsule, 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 2027 (October 1, 2026 through September 30, 2027) 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 right shoulder joint. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Injury, sequela.

This medical diagnosis code is frequently used in Orthopedics medical specialties to designate conditions such selected sprains rotator cuff, cruciate ligament, and ankle.

Code Identity

ICD-10-CM Code
S43.421S
Billable Status
Yes — Valid for Submission
Code Describes
Sprain of right rotator cuff capsule, sequela
Short Description
Sprain of right rotator cuff capsule, sequela
Same as the full description in the CMS dataset.
Parent Code
S43.421
Sprain of right rotator cuff capsule

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 CodeS43.421SSprain of right rotator cuff capsule, sequela

Present on Admission (POA)Billing

S43.421S is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Injuries to the shoulder and upper arm (S40-S49).

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Disorder of ligament of right shoulder joint
  • Disorder of ligament of right shoulder region
  • Sprain of ligament of right shoulder joint
  • Sprain of right rotator cuff capsule
  • 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 2027, published by CMS and the National Center for Health Statistics.

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to S43.421S: its own notes plus those printed at S43.42, S43, block S40-S49, and Chapter 19. A note printed at a category, block or chapter applies to every code under it.

Includes

Further defines, or gives examples of, the content of the category.

From S43 Dislocation and sprain of joints and ligaments of shoulder girdle applies to 333 codes
  • avulsion of joint or ligament of shoulder girdle
  • laceration of cartilage, joint or ligament of shoulder girdle
  • sprain of cartilage, joint or ligament of shoulder girdle
  • traumatic hemarthrosis of joint or ligament of shoulder girdle
  • traumatic rupture of joint or ligament of shoulder girdle
  • traumatic subluxation of joint or ligament of shoulder girdle
  • traumatic tear of joint or ligament of shoulder girdle
From Block S40-S49 Injuries to the shoulder and upper arm applies to 2,730 codes
  • injuries of axilla
  • injuries of scapular region

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From S43.42 Sprain of rotator cuff capsule applies to 9 codes
  • rotator cuff syndrome (complete) (incomplete), not specified as traumatic (M75.1-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From S43.42 Sprain of rotator cuff capsule applies to 9 codes
  • injury of tendon of rotator cuff (S46.0-)
From S43 Dislocation and sprain of joints and ligaments of shoulder girdle applies to 333 codes
  • strain of muscle, fascia and tendon of shoulder and upper arm (S46.-)
From Block S40-S49 Injuries to the shoulder and upper arm applies to 2,730 codes
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • code to identify any retained foreign body, if applicable (Z18.-)

Code Also

A second code may be needed to fully describe the condition; the note gives no sequencing direction.

From S43 Dislocation and sprain of joints and ligaments of shoulder girdle applies to 333 codes
  • any associated open wound

Notes

General instructions on how these codes are used.

From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
  • The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

7th Character

Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.

From S43 Dislocation and sprain of joints and ligaments of shoulder girdle applies to 333 codes
  • The appropriate 7th character is to be added to each code from category S43
Values for category S43 Encounter: Initial, Subsequent, Sequela
  • Ainitial encounter
  • Dsubsequent encounter
  • Ssequela this code

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR INJ073
Injury, sequela
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Rotator Cuff Injuries

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.

The full article covers:

  • What is a rotator cuff?
  • What are rotator cuff injuries?
  • Who is more likely to develop a rotator cuff injury?
  • What are the symptoms of rotator cuff injuries?
  • How are rotator cuff injuries diagnosed?
  • What are the treatments for rotator cuff injuries?
  • When should I see a health care provider for shoulder pain?

Read the full article at MedlinePlus

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

Convert S43.421S to ICD-9-CMHistory

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

ICD-9-CM
905.7 Late effec sprain/strain
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 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About S43.421SOverview

What is the ICD-10 code for sprain of right rotator cuff capsule, sequela?

The ICD-10-CM code for sprain of right rotator cuff capsule, sequela is S43.421S (sometimes written as S43421S). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is S43.421S (Sprain of right rotator cuff capsule) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report sprain of right rotator cuff capsule, sequela on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character S in S43.421S mean?

The final character S makes this a sequela code: it reports a lingering problem that remains after the sprain of right rotator cuff capsule itself has resolved, not the original event.

What MS-DRG does S43.421S group to?

When sprain of right rotator cuff capsule, sequela is the principal diagnosis on an inpatient stay, it groups to MS-DRG 563, 562, with relative weights from 0.8982 to 1.3981 depending on complications. Higher weights mean higher Medicare reimbursement.

Is S43.421S 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 right rotator cuff capsule, sequela on inpatient claims. The code appears in the Injuries to the shoulder and upper arm (S40-S49) range of the CMS exempt list.