2022 ICD-10-CM Code S56.919S
Strain of unspecified muscles, fascia and tendons at forearm level, unspecified arm, sequela
Code Classification
S56.919S is a billable diagnosis code used to specify a medical diagnosis of strain of unspecified muscles, fascia and tendons at forearm level, unspecified arm, sequela. The code S56.919S is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
The ICD-10-CM code S56.919S might also be used to specify conditions or terms like forearm sprain, rupture of tendon of elbow, rupture of tendon of thumb, rupture tendon forearm or wrist, strain of muscle and/or tendon of elbow region , strain of muscle and/or tendon of forearm, etc. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
S56.919S is a sequela code, includes a 7th character and should be used for complications that arise as a direct result of a condition like strain of unspecified muscles fascia and tendons at forearm level unspecified arm. According to ICD-10-CM Guidelines a "sequela" code should be used for chronic or residual conditions that are complications of an initial acute disease, illness or injury. The most common sequela is pain. Usually, two diagnosis codes are needed when reporting sequela. The first code describes the nature of the sequela while the second code describes the sequela or late effect.
Unspecified diagnosis codes like S56.919S are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.
Coding Guidelines
The appropriate 7th character is to be added to each code from block Injury of muscle, fascia and tendon at forearm level (S56). Use the following options for the aplicable episode of care:
- A - initial encounter
- D - subsequent encounter
- S - sequela
Approximate Synonyms
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Forearm sprain
- Rupture of tendon of elbow
- Rupture of tendon of thumb
- Rupture tendon forearm or wrist
- Strain of muscle and/or tendon of elbow region
- Strain of muscle and/or tendon of forearm
Diagnostic Related Groups - MS-DRG Mapping
The ICD-10 code S56.919S is grouped in the following groups for version MS-DRG V39.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC). applicable from 10/01/2021 through 09/30/2022.
| MS-DRG | MS-DRG Title | MCD | Relative Weight |
|---|---|---|---|
| 562 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC | 08 | 1.408 |
| 563 | FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC | 08 | 0.8708 |
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.
Present on Admission (POA)
S56.919S is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.
CMS POA Indicator Options and Definitions
| POA Indicator Code | POA Reason for Code | CMS will pay the CC/MCC DRG? |
|---|---|---|
| Y | Diagnosis was present at time of inpatient admission. | YES |
| N | Diagnosis was not present at time of inpatient admission. | NO |
| U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
| W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
| 1 | Unreported/Not used - Exempt from POA reporting. | NO |
Convert S56.919S to ICD-9 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code S56.919S its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
- 905.7 - Late effec sprain/strain (Approximate Flag)
Information for Patients
Arm Injuries and Disorders
Of the 206 bones in your body, three of them are in your arm: the humerus, radius, and ulna. Your arms are also made up of muscles, joints, tendons, and other connective tissue. Injuries to any of these parts of the arm can occur during sports, a fall, or an accident.
Types of arm injuries include
- Tendinitis and bursitis
- Sprains
- Dislocations
- Fractures (broken bones)
- Nerve problems
- Osteoarthritis
You may also have problems or injure specific parts of your arm, such as your hand, wrist, elbow, or shoulder.
[Learn More in MedlinePlus]
Sprains and Strains
A sprain is a stretched or torn ligament. Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting hit can all cause a sprain. Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising, and being unable to move your joint. You might feel a pop or tear when the injury happens.
A strain is a stretched or torn muscle or tendon. Tendons are tissues that connect muscle to bone. Twisting or pulling these tissues can cause a strain. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common. Many people get strains playing sports. Symptoms include pain, muscle spasms, swelling, and trouble moving the muscle.
At first, treatment of both sprains and strains usually involves resting the injured area, icing it, wearing a bandage or device that compresses the area, and medicines. Later treatment might include exercise and physical therapy.
NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases
[Learn More in MedlinePlus]
Related Codes
| ICD Code | Description | Valid for Submission |
|---|---|---|
| S56 | Injury of muscle, fascia and tendon at forearm level | NON-BILLABLE CODE |
| S56.0 | Injury of flexor muscle, fascia and tendon of thumb at forearm level | NON-BILLABLE CODE |
| S56.00 | Unspecified injury of flexor muscle, fascia and tendon of thumb at forearm level | NON-BILLABLE CODE |
| S56.001 | Unspecified injury of flexor muscle, fascia and tendon of right thumb at forearm level | NON-BILLABLE CODE |
| S56.001A | Unspecified injury of flexor muscle, fascia and tendon of right thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.001D | Unspecified injury of flexor muscle, fascia and tendon of right thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.001S | Unspecified injury of flexor muscle, fascia and tendon of right thumb at forearm level, sequela | BILLABLE CODE |
| S56.002 | Unspecified injury of flexor muscle, fascia and tendon of left thumb at forearm level | NON-BILLABLE CODE |
| S56.002A | Unspecified injury of flexor muscle, fascia and tendon of left thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.002D | Unspecified injury of flexor muscle, fascia and tendon of left thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.002S | Unspecified injury of flexor muscle, fascia and tendon of left thumb at forearm level, sequela | BILLABLE CODE |
| S56.009 | Unspecified injury of flexor muscle, fascia and tendon of unspecified thumb at forearm level | NON-BILLABLE CODE |
| S56.009A | Unspecified injury of flexor muscle, fascia and tendon of unspecified thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.009D | Unspecified injury of flexor muscle, fascia and tendon of unspecified thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.009S | Unspecified injury of flexor muscle, fascia and tendon of unspecified thumb at forearm level, sequela | BILLABLE CODE |
| S56.01 | Strain of flexor muscle, fascia and tendon of thumb at forearm level | NON-BILLABLE CODE |
| S56.011 | Strain of flexor muscle, fascia and tendon of right thumb at forearm level | NON-BILLABLE CODE |
| S56.011A | Strain of flexor muscle, fascia and tendon of right thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.011D | Strain of flexor muscle, fascia and tendon of right thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.011S | Strain of flexor muscle, fascia and tendon of right thumb at forearm level, sequela | BILLABLE CODE |
| S56.012 | Strain of flexor muscle, fascia and tendon of left thumb at forearm level | NON-BILLABLE CODE |
| S56.012A | Strain of flexor muscle, fascia and tendon of left thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.012D | Strain of flexor muscle, fascia and tendon of left thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.012S | Strain of flexor muscle, fascia and tendon of left thumb at forearm level, sequela | BILLABLE CODE |
| S56.019 | Strain of flexor muscle, fascia and tendon of unspecified thumb at forearm level | NON-BILLABLE CODE |
| S56.019A | Strain of flexor muscle, fascia and tendon of unspecified thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.019D | Strain of flexor muscle, fascia and tendon of unspecified thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.019S | Strain of flexor muscle, fascia and tendon of unspecified thumb at forearm level, sequela | BILLABLE CODE |
| S56.02 | Laceration of flexor muscle, fascia and tendon of thumb at forearm level | NON-BILLABLE CODE |
| S56.021 | Laceration of flexor muscle, fascia and tendon of right thumb at forearm level | NON-BILLABLE CODE |
| S56.021A | Laceration of flexor muscle, fascia and tendon of right thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.021D | Laceration of flexor muscle, fascia and tendon of right thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.021S | Laceration of flexor muscle, fascia and tendon of right thumb at forearm level, sequela | BILLABLE CODE |
| S56.022 | Laceration of flexor muscle, fascia and tendon of left thumb at forearm level | NON-BILLABLE CODE |
| S56.022A | Laceration of flexor muscle, fascia and tendon of left thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.022D | Laceration of flexor muscle, fascia and tendon of left thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.022S | Laceration of flexor muscle, fascia and tendon of left thumb at forearm level, sequela | BILLABLE CODE |
| S56.029 | Laceration of flexor muscle, fascia and tendon of unspecified thumb at forearm level | NON-BILLABLE CODE |
| S56.029A | Laceration of flexor muscle, fascia and tendon of unspecified thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.029D | Laceration of flexor muscle, fascia and tendon of unspecified thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.029S | Laceration of flexor muscle, fascia and tendon of unspecified thumb at forearm level, sequela | BILLABLE CODE |
| S56.09 | Other injury of flexor muscle, fascia and tendon of thumb at forearm level | NON-BILLABLE CODE |
| S56.091 | Other injury of flexor muscle, fascia and tendon of right thumb at forearm level | NON-BILLABLE CODE |
| S56.091A | Other injury of flexor muscle, fascia and tendon of right thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.091D | Other injury of flexor muscle, fascia and tendon of right thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.091S | Other injury of flexor muscle, fascia and tendon of right thumb at forearm level, sequela | BILLABLE CODE |
| S56.092 | Other injury of flexor muscle, fascia and tendon of left thumb at forearm level | NON-BILLABLE CODE |
| S56.092A | Other injury of flexor muscle, fascia and tendon of left thumb at forearm level, initial encounter | BILLABLE CODE |
| S56.092D | Other injury of flexor muscle, fascia and tendon of left thumb at forearm level, subsequent encounter | BILLABLE CODE |
| S56.092S | Other injury of flexor muscle, fascia and tendon of left thumb at forearm level, sequela | BILLABLE CODE |
| S56.099 | Other injury of flexor muscle, fascia and tendon of unspecified thumb at forearm level | NON-BILLABLE CODE |
Code History
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)