R16.1 — Splenomegaly, not elsewhere classified
R16.1 is a billable, specific ICD-10-CM code for splenomegaly, not elsewhere classified. It is valid for submission on a claim.
Inclusion 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
These codes carry an Excludes1 note pointing at R16.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading R16.1 alone.
- D73.1Hypersplenism
Risk adjustment
R16.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
R16.1 is named in 40 Medicare coverage policies — 40 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A55717Billing and Coding: Lab: Flow Cytometry
- A56199Billing and Coding: Molecular Pathology Procedures
- A56199Billing and Coding: Molecular Pathology Procedures
- A56199Billing and Coding: Molecular Pathology Procedures
How R16.1 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to R16.1.
- Débove's disease(splenomegaly)
- Splenomegaly, splenomegalia(Bengal) (cryptogenic) (idiopathic) (tropical)
- Disease, diseased›Débove's(splenomegaly)
- Mass›splenic
Related codes at this level
Codes that share R16. If R16.1 is not quite right, the correct code is usually one of these.
Questions about R16.1
- Is R16.1 a billable ICD-10-CM code?
- Yes. R16.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does R16.1 sit in the tabular list?
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block Symptoms and signs involving the digestive system and abdomen (R10-R19).