2026 ICD-10-CM Diagnosis Code S43.429ASprain of unspecified rotator cuff capsule, initial encounter
S43.429A is a billable ICD-10-CM diagnosis code for sprain of unspecified rotator cuff capsule, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. 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, 963 through 965. Coders also document this condition as sprain of shoulder rotator cuff. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sprains and strains, initial encounter.
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
Code Classification
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Sprain of shoulder rotator cuff
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
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 S43.429A to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S43.429AOverview
Is S43.429A (Sprain of unspecified rotator cuff capsule) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report sprain of unspecified rotator cuff capsule, initial encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character A in S43.429A mean?
The final character A marks the initial encounter: use it while the patient is receiving active treatment for sprain of unspecified rotator cuff capsule, such as an emergency visit or first evaluation.
What MS-DRG does S43.429A group to?
When sprain of unspecified rotator cuff capsule, initial encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 562, 563, 963, 964, 965, with relative weights from 0.8955 to 2.7338 depending on complications. Higher weights mean higher Medicare reimbursement.
What is the ICD-9 equivalent of S43.429A?
Under the General Equivalence Mappings, sprain of unspecified rotator cuff capsule, initial encounter converts to ICD-9-CM 840.4 (sprain rotator cuff). 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.
