2027 ICD-10-CM Diagnosis Code S43.491DOther sprain of right shoulder joint, subsequent encounter

ICD-10-CM Codes›S00–T88›S40-S49›S43

ICD-10-CM S43.491D
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

S43.491D is a billable ICD-10-CM diagnosis code for other sprain of right 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 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 949 through 950. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sprains and strains, subsequent encounter.

Code Identity

ICD-10-CM Code
S43.491D
Billable Status
Yes — Valid for Submission
Code Describes
Other sprain of right shoulder joint, subsequent encounter
Short Description
Other sprain of right shoulder joint, subsequent encounter
Same as the full description in the CMS dataset.
Parent Code
S43.491
Other sprain of right 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 CodeS43.491DOther sprain of right shoulder joint, subsequent encounter

Present on Admission (POA)Billing

S43.491D 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).

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 S43.491D: its own notes plus those printed at 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

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 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 this code
  • Ssequela

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 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 S43.491D 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 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About S43.491DOverview

What is the ICD-10 code for other sprain of right shoulder joint, subsequent encounter?

The ICD-10-CM code for other sprain of right shoulder joint, subsequent encounter is S43.491D (sometimes written as S43491D). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is S43.491D (Other sprain of right shoulder joint) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report other sprain of right shoulder joint, subsequent encounter on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character D in S43.491D mean?

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

What MS-DRG does S43.491D group to?

When other sprain of right shoulder joint, subsequent encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 950, 949, with relative weights from 0.7661 to 1.1231 depending on complications. Higher weights mean higher Medicare reimbursement.

Is S43.491D 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 other sprain of right shoulder joint, subsequent encounter on inpatient claims. The code appears in the Injuries to the shoulder and upper arm (S40-S49) range of the CMS exempt list.