{"id":183527,"date":"2026-08-18T09:01:46","date_gmt":"2026-08-18T09:01:46","guid":{"rendered":"https:\/\/pabau.com\/?p=183527"},"modified":"2026-08-18T12:19:25","modified_gmt":"2026-08-18T12:19:25","slug":"icd-10-code-s46191a","status":"publish","type":"post","link":"https:\/\/pabau.com\/de\/diagnostic-codes\/icd-10-code-s46191a\/","title":{"rendered":"ICD-10 code S46.191A: Biceps long head injury, right arm"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"ICD-10 code S46.191A: Biceps long head injury, right arm\",\"description\":\"ICD-10 code S46.191A covers other injury of muscle, fascia and tendon of the long head of biceps, right arm, initial encounter. Billable status, character breakdown, sibling codes, ICD-9 crosswalk, and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s46191a\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-10\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>ICD-10 code S46.191A means other injury of muscle, fascia and tendon of the long head of biceps, right arm, initial encounter.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>S46.191A is a billable ICD-10-CM code, valid for HIPAA-covered claims and unchanged in the FY2026 edition effective October 1, 2025.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The code already names the right arm, so the open question is the injury type rather than the anatomy.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The 7th character A covers active treatment. Use S46.191D for later healing visits and S46.191S for a sequela.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps an ICD-10-CM code library inside the patient record, so the code you document seeds the claim form.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">ICD-10 code S46.191A covers an &#8222;other&#8220; injury of the long head of the biceps, right arm, at an initial encounter. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The word &#8222;other&#8220; makes the code sound like a dumping ground. It&#8217;s much narrower than that, because the structure and the side are already fixed. Only the injury type stays open.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That misreading is what sends claims back. A coder sees &#8222;shoulder muscle injury&#8220; in a note and reaches for a biceps code. Or the chart names the side, yet the claim goes out unspecified anyway. Both mistakes stop once you can read the six characters in front of the A.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"ICD-10 Revisions: Stay Updated or Fall Behind\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/bqAyb-BCA0w?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-what-s46-191a-covers-in-one-line\" class=\"wp-block-heading\">What S46.191A covers, in one line<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S46.191A means other injury of muscle, fascia and tendon of the long head of biceps, right arm, initial encounter. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It is a billable, specific ICD-10-CM code, so it can stand on its own as a diagnosis. The FY2026 edition took effect on October 1, 2025, and the wording did not change.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S46.191A<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other injury of muscle, fascia and tendon of long head of biceps, right arm, initial encounter<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short description<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Inj musc\/fasc\/tend long head of biceps, right arm, init<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Structure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Long head of the biceps: muscle, fascia and tendon<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Laterality<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right arm, named by the 6th character<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Injury type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other injury, so neither unspecified, strain, nor laceration<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billable\/specific<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, valid for HIPAA-covered claim submission<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Effective date<\/td>\n<td style=\"padding:12px 16px;color:#374151\">October 1, 2025 for the FY2026 edition; first valid in FY2016<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code block<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S40-S49, injuries to the shoulder and upper arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code set<\/td>\n<td style=\"padding:12px 16px;color:#374151\">American ICD-10-CM, which differs from international ICD-10<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Check the wording against the official tabular list before you appeal a denial. The <a href=\"https:\/\/icd10cmtool.cdc.gov\/\" target=\"_blank\" rel=\"nofollow noopener\">CDC ICD-10-CM browser tool<\/a> publishes the current entry for every code in the S46 category, including the notes that sit above it.<\/p>\n\n\n\n<h2 id=\"h-why-a-biceps-code-sits-in-the-shoulder-block\" class=\"wp-block-heading\">Why a biceps code sits in the shoulder block<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The long head of the biceps starts inside the shoulder. Its tendon anchors at the supraglenoid tubercle of the scapula, crosses the joint, then runs down through the bicipital groove of the humerus. An injury there is anatomically a shoulder problem, which is why S46.1 lives in the S40-S49 block.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The elbow end belongs elsewhere. S46 carries a Type 2 Excludes note for injury of muscle, fascia and tendon at the elbow. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That note sends distal biceps injuries to the S56 category. Type 2 means the two conditions can coexist, so both codes may appear on one claim when the record supports each.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Four nearby boundaries are worth memorizing:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>S46.2<\/strong> covers other parts of the biceps, so the short head and the rest of the muscle belly sit here.<\/li>\n\n\n\n<li><strong>S46.3<\/strong> covers the triceps at the same shoulder and upper arm level.<\/li>\n\n\n\n<li><strong>M75.21<\/strong> is bicipital tendinitis of the right shoulder. Overuse and inflammation belong in Chapter 13, not in an injury code.<\/li>\n\n\n\n<li><strong>S43.43-<\/strong> covers a superior glenoid labrum lesion. A biceps anchor tear that takes the labrum with it is a labral injury, which the <a href=\"https:\/\/pabau.com\/templates\/biceps-load-test\/\">biceps load test<\/a> helps pin down.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-the-vague-part-of-s46-191a-is-the-injury-type\" class=\"wp-block-heading\">The vague part of S46.191A is the injury type<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Under S46.1, the 5th character carries the injury type and the 6th carries the side. Coders often read it the other way around and assume the &#8222;other&#8220; refers to the muscle. It never does. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Four options fill that 5th slot.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Stem<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">5th character<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Use it when the note says<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">0, unspecified injury<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The long head is injured, with no type named<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1, strain<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Strain of the long head of the biceps<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.12<\/td>\n<td style=\"padding:12px 16px;color:#374151\">2, laceration<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The muscle or tendon was cut or torn open<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.19<\/td>\n<td style=\"padding:12px 16px;color:#374151\">9, other injury<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A named injury that fits none of the three above<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The 6th character then picks the side. Use 1 for the right arm, 2 for the left arm, and 9 when the record never says. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So S46.191A has no laterality problem at all. A query on this code is almost always about injury type or encounter phase.<\/p>\n\n\n\n<h2 id=\"h-break-the-code-down-character-by-character\" class=\"wp-block-heading\">Break the code down, character by character<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Each character narrows the code by one decision. Walking down the tree is the fastest way to prove you landed on the right one.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Level<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it adds<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Chapter 19<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S00-T88<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injury, poisoning and certain other consequences of external causes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Block<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S40-S49<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injuries to the shoulder and upper arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S46<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Injury of muscle, fascia and tendon at shoulder and upper arm level<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">4th character<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S46.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The structure: long head of the biceps<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">5th character<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S46.19<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The injury type: other injury<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">6th character<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S46.191<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The side: right arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">7th character<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S46.191A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The encounter: initial<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Only the full seven characters bill. S46.19 and S46.191 are stems, so a claim carrying either one rejects as an invalid code. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you prefer to browse the tree, the <a href=\"https:\/\/www.aapc.com\/codes\/icd-10-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC ICD-10-CM code lookup<\/a> lists the same branches with their index references.<\/p>\n\n\n\n<h2 id=\"h-the-7th-character-a-tracks-active-treatment-not-visit-number\" class=\"wp-block-heading\">The 7th character A tracks active treatment, not visit number<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A stands for initial encounter, and initial encounter means active treatment. Visit number has nothing to do with it. Someone on their fourth appointment still codes to A while the surgeon actively treats the injury.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Every Chapter 19 injury code needs one of these three characters. A tendon sheath injection reported with CPT <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20550\/\">20550<\/a> is still active treatment, so it takes A as well.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">7th character<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Encounter type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Use it when<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.191A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active treatment is under way: first assessment, surgery, immobilization, or the initial therapy evaluation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.191D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Routine care while the injury heals, such as follow-up checks and continued therapy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.191S<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sequela<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A residual condition remains after the injury has healed, such as lasting weakness<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h3 class=\"wp-block-heading\">When to switch from A to D<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Switch once the plan of care shifts from treating the injury to watching it heal. A wound check, a <a href=\"https:\/\/pabau.com\/templates\/shoulder-range-of-motion-template\/\">range-of-motion review<\/a>, or a therapy session under an established plan all take the D character. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Carrying A through eight weeks of therapy is what costs practices money. The payer usually flags it weeks later, long after anyone remembers the visit.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">When sequela (S) applies<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Sequela coding needs two codes and a specific order. List the residual condition first, then S46.191S for the injury that caused it. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Chronic weakness or a stiff shoulder months after the original event fits this pattern. Never add A or D alongside S for the same injury.<\/p>\n\n\n\n<h2 id=\"h-codes-coders-reach-for-by-mistake\" class=\"wp-block-heading\">Codes coders reach for by mistake<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most mix-ups come from the neighbors below. Each one differs from S46.191A by the structure, the injury type, or the side. All are initial-encounter codes, so you can compare them line by line.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description, initial encounter<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Pick it instead when<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.191A<\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>Other injury of muscle, fascia and tendon of long head of biceps, right arm<\/strong><\/td>\n<td style=\"padding:12px 16px;color:#374151\"><strong>The note names a right long head injury that is not a strain or a laceration<\/strong><\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.101A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified injury of muscle, fascia and tendon of long head of biceps, right arm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The long head is injured, but the type is never documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.111A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Strain of muscle, fascia and tendon of long head of biceps, right arm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The provider documented a strain<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.192A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other injury of muscle, fascia and tendon of long head of biceps, left arm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The injury is on the left side<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.199A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other injury of muscle, fascia and tendon of long head of biceps, unspecified arm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Nothing in the record names a side<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.091A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other injury of muscle(s) and tendon(s) of the rotator cuff of right shoulder<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The rotator cuff is the injured structure<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.891A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other injury of other muscles, fascia and tendons at shoulder and upper arm level, right arm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A named muscle is injured that is neither the biceps nor the cuff<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S46.991A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other injury of unspecified muscle, fascia and tendon at shoulder and upper arm level, right arm<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The muscle is never identified anywhere in the chart<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">S46.8 is where the catch-all for other muscles at this level lives. Reading S46.191A as a spare bucket for shoulder soft tissue is the most common error on this code. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cuff problems are the other frequent detour. A positive <a href=\"https:\/\/pabau.com\/blog\/neers-test\/\">Neer\u2019s test<\/a> points at impingement rather than the long head, and an atraumatic complete cuff tear codes to <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-m75121\/\">M75.121<\/a>.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>When a note reads &#8222;right shoulder muscle injury&#8220; with no structure named, query the chart before you code. S46.191A only holds if the record puts the injury in the long head of the biceps. If the provider names the deltoid or the teres major instead, S46.891A is the correct family. If nobody names a muscle at all, S46.991A is the honest answer, and it invites a payer query you can avoid with one question.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-the-icd-9-crosswalk-is-959-2-and-only-approximate\" class=\"wp-block-heading\">The ICD-9 crosswalk is 959.2, and only approximate<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS General Equivalence Mappings, or GEMs, convert S46.191A to ICD-9-CM 959.2, shoulder and upper arm injury. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The mapping loses almost everything useful. ICD-9 959.2 covered any unspecified injury in the region, so it carries no structure, no side, and no encounter phase.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Legacy registries and retrospective research still ask for the ICD-9 code. Claims do not. Any date of service from October 1, 2015 onward needs the ICD-10-CM code instead. Check the GEMs files published by <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/icd-10-codes\" target=\"_blank\" rel=\"nofollow noopener\">CMS<\/a> if a payer or registry asks you to map in either direction.<\/p>\n\n\n\n<h2 id=\"h-what-the-note-must-say-before-you-bill-s46-191a\" class=\"wp-block-heading\">What the note must say before you bill S46.191A<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Seven checks decide whether this code holds up under review. Miss one and the claim either drops to an unspecified sibling or comes back for more information.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Structure:<\/strong> the note names the long head of the biceps. &#8222;Biceps tendon&#8220; alone leaves a coder choosing between S46.1 and S46.2.<\/li>\n\n\n\n<li><strong>Injury type:<\/strong> the record describes a named injury that is neither a strain nor a laceration.<\/li>\n\n\n\n<li><strong>Side:<\/strong> the note says right arm. The 6th character is already committed, so a left-sided note sends you to S46.192A.<\/li>\n\n\n\n<li><strong>Encounter phase:<\/strong> the chart shows active treatment on this date rather than routine follow-up.<\/li>\n\n\n\n<li><strong>Mechanism:<\/strong> how the injury happened. Chapter 19 asks for a secondary external cause code from Chapter 20.<\/li>\n\n\n\n<li><strong>Open wound:<\/strong> S46 carries a Code Also note for an associated open wound, which lives in the S41 category. A right shoulder laceration with a foreign body, for example, is <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s41021a\/\">S41.021A<\/a>.<\/li>\n\n\n\n<li><strong>Retained foreign body:<\/strong> add a code from Z18 when something is still in the wound.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">These details are cheap to capture at the point of care and expensive to chase later. A coder who has to email a provider three days after the visit is already working against the clock. Good <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">clinical record keeping<\/a> puts the answer inside the chart instead.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/diagnostic_codes\/icd-10-code-s46191a\/comprehensive-emr-patient-record-management.webp\" alt=\"Pabau EMR patient record with clinical notes and history\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s patient record holds the note, the history, and the codes in one place. That makes the structure and the side easy to confirm before you bill.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-which-practices-report-this-code\" class=\"wp-block-heading\">Which practices report this code<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Orthopedics, physical therapy, sports medicine, emergency departments, and workers\u2019 comp billing account for nearly all S46.191A claims. The code stays the same across them. What changes is how quickly the encounter phase moves on.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical encounter<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Watch out for<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Orthopedics<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First assessment, imaging review, surgical consult<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Post-op visits move to D once treatment is established<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physical therapy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial evaluation and plan of care<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A applies to the evaluation, then later sessions take D<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Sports medicine<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sideline assessment, first office visit in season<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A applies throughout active treatment, so confirm the phase<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Emergency medicine<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acute presentation after trauma<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add the external cause code for the mechanism<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Workers&#8217; comp<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First report of injury, first medical evaluation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">State rules differ, so check the board before you submit<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Workers\u2019 comp deserves its own note. State boards set their own billing rules, and several ask for external cause codes covering the mechanism and the place of injury. No blanket statement covers them all, so confirm with the applicable board or payer.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Therapy and sports practices carry the other risk, because they see the same shoulder many times. <a href=\"https:\/\/pabau.com\/industry\/physical-therapy-emr\/\">Physical therapy software<\/a> and <a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">sports medicine workflows<\/a> keep the visit history next to the note, which makes the phase easy to check.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-the-code-and-the-note-in-one-record\" class=\"wp-block-heading\">How Pabau keeps the code and the note in one record<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Plenty of practices split this job across two screens. The note sits in the chart, the code sits in a lookup tab, and someone re-types the result into the claim. Every re-key is another chance for S46.191A to arrive as S46.199A.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps the reference inside the chart. Its ICD-10-CM and CPT libraries hold more than 20,000 codes and refresh with each official release. A coder can search S46.1 without leaving the encounter, and codes recorded on the patient record then seed the claim form.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Pabau&#8217;s claims management<\/a> checks that the fields your payer requires are complete before submission unlocks. It will not choose your 7th character for you. That call stays with the coder, which is why the wording in the note matters more than any software setting.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation is the other half of the problem. <a href=\"https:\/\/pabau.com\/features\/ai-medical-scribe\/\">Pabau Scribe<\/a>, our AI scribe, drafts the consultation note while the appointment happens. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When a provider says &#8222;partial tear of the right long head of biceps&#8220;, that phrase reaches the record instead of someone&#8217;s memory. The coder then has the structure, the side, and the phase in front of them.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/diagnostic_codes\/icd-10-code-s46191a\/track-claims-from-start-to-finish.webp\" alt=\"Pabau claims dashboard showing claim status from submission to payment\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s claims view shows where each submission stands, so a returned shoulder injury claim gets picked up in days rather than weeks.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep ICD-10 coding and claims in one record                <\/h3>\n\n                <p class=\"description\">\n                    Pabau puts a refreshed ICD-10-CM library inside the patient record. Codes you document seed the claim form, and payer-required fields are checked before you submit.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S46.191A rewards a note that names the structure, the side, and the phase of care. Get those three right and the claim rarely comes back.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two habits keep it clean. Read the 5th character as the injury type and the 6th as the side. Then confirm the visit is still active treatment before you commit to the A character. When the note names another muscle, move to the S46.8 family instead.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau keeps the code library and the clinical note in the same record, which makes both checks quick. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how your team could code shoulder injuries and bill them from one place.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding another injury in the same block?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s49109p\/\">S49.109P<\/a> covers a distal humerus growth plate malunion.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the sequela side of the same chapter?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s43312s\/\">S43.312S<\/a> shows how to sequence a residual condition ahead of the injury code.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing the shoulder surgery that follows?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-23462\/\">23462<\/a> walks through a capsule repair claim, with RVUs and modifiers.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Working at the same anatomical level?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-24076\/\">24076<\/a> covers a subfascial soft tissue excision in the upper arm.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Tightening up your billing routine?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/medical-billing-compliance\/\">Medical billing compliance<\/a> covers the checks that keep audits quiet.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1787042354885\"><h3 class=\"schema-faq-question\">Can S46.191A and a rotator cuff code go on the same claim?<\/h3> <p class=\"schema-faq-answer\">Yes, when the record documents both structures. S46.1 and S46.0 are separate subcategories with no Excludes1 conflict between them. Sequence the code that matches the reason for the visit first.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042354886\"><h3 class=\"schema-faq-question\">Is there an S46.191B for an open injury?<\/h3> <p class=\"schema-faq-answer\">No. S46 codes take only A, D, or S. The B character belongs to fracture codes. For an open injury, follow the Code Also note on S46 and add the open wound code from the S41 category.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042354887\"><h3 class=\"schema-faq-question\">Does a biceps tendon rupture code to S46.191A?<\/h3> <p class=\"schema-faq-answer\">It depends on the wording. A documented strain goes to S46.111A and a laceration to S46.121A. An atraumatic, degenerative problem falls outside Chapter 19, so bicipital tendinitis of the right shoulder codes to M75.21.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042354888\"><h3 class=\"schema-faq-question\">Which MS-DRGs does S46.191A group to?<\/h3> <p class=\"schema-faq-answer\">On an inpatient claim, S46.191A groups to MS-DRG 913 or 914 for traumatic injury, with or without an MCC. It can also fall into 963, 964, or 965 for other multiple significant trauma.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042354890\"><h3 class=\"schema-faq-question\">Can S46.191A be the primary diagnosis?<\/h3> <p class=\"schema-faq-answer\">Yes. It is a specific billable code, so it can be first-listed when the injury is the reason for the visit. Chapter 19 also asks for an external cause code, which is always secondary. On a sequela claim, the residual condition goes first.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>S46.191A means other injury of the long head of biceps, right arm, initial encounter. Only the injury type is open. Read more.<\/p>\n","protected":false},"author":85,"featured_media":183526,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"86","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1549,1550],"tags":[3676,2972,1543,1305,1666],"class_list":["post-183527","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-diagnostic-codes","category-icd-10-cm","tag-biceps-tendon-pain","tag-clinical-coding","tag-clinical-documentation","tag-icd-10-codes","tag-orthopedic-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>ICD-10 code S46.191A: Biceps long head injury, right arm<\/title>\n<meta name=\"description\" content=\"S46.191A means other injury of the long head of biceps, right arm, initial encounter. 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