R16.1
R16.1: Splenomegaly, not elsewhere classified
Billable / specific codeICD-10-CM
R16.1 is a billable, specific ICD-10-CM code for splenomegaly, not elsewhere classified. It is valid for submission on a claim.
Check R16.1 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Splenomegaly NOS
Other codes that can never be billed with R16.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
- D73.1Hypersplenism
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
R16.1 is named in 24 Medicare coverage policies: 24 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A55717Billing and Coding: Lab: Flow Cytometry
- A56199Billing and Coding: Molecular Pathology Procedures
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A56464Billing and Coding: Flow Cytometry
Alphabetic index entries that lead here
- Débove's disease(splenomegaly)
- Splenomegaly, splenomegalia(Bengal) (cryptogenic) (idiopathic) (tropical)
- Disease, diseased›Débove's(splenomegaly)
- Mass›splenic
Code history
Unchanged in every release from FY2024 to FY2027.