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ICD-10 Guide
ICD-10 CodesR19.03

R19.03

Right lower quadrant abdominal swelling, mass and lump

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R19.03 is a billable code used to indicate a diagnosis of right lower quadrant abdominal swelling, mass and lump.

Key Diagnostic Point:

R19.03 refers to the clinical presentation of swelling, mass, or lump specifically located in the right lower quadrant of the abdomen. This symptom can arise from various underlying conditions, including gastrointestinal, gynecological, or urological issues. Common causes include appendicitis, ovarian cysts, hernias, and tumors. Patients may present with additional symptoms such as pain, tenderness, changes in bowel habits, or urinary symptoms. Clinical examination often reveals a palpable mass, which may be associated with signs of inflammation or obstruction. Diagnostic imaging, such as ultrasound or CT scans, is frequently employed to ascertain the nature of the mass and guide further management. Accurate documentation of the size, consistency, and associated symptoms is crucial for effective coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying conditions
  • Need for precise documentation of symptoms
  • Differentiation from similar abdominal codes
  • Potential for overlapping diagnoses

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the nature of the mass
  • Misuse of related codes leading to upcoding or downcoding
  • Lack of correlation between diagnosis and treatment

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history and physical examination notes, including size and characteristics of the mass.

Common Clinical Scenarios

Patients presenting with abdominal pain and a palpable mass during routine examinations.

Billing Considerations

Ensure that all relevant symptoms and findings are documented to support the diagnosis.

Emergency Medicine

Documentation Requirements

Acute care notes must include time of presentation, vital signs, and immediate findings.

Common Clinical Scenarios

Patients with acute abdominal pain and swelling requiring urgent evaluation.

Billing Considerations

Rapid assessment and documentation of findings are critical for accurate coding and treatment.

Coding Guidelines

Inclusion Criteria

Use R19.03 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is supported by clinical documentation and that all relevant symptoms are captured

Exclusion Criteria

Do NOT use R19.03 When
No specific exclusions found.

Related CPT Codes

74176CPT Code

CT abdomen and pelvis with contrast

Clinical Scenario

Used to evaluate abdominal masses in patients presenting with swelling.

Documentation Requirements

Indicate the reason for the CT scan and any relevant clinical findings.

Specialty Considerations

Ensure that the imaging is justified based on clinical presentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of symptoms like R19.03, improving the granularity of data for clinical analysis and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of symptoms like R19.03, improving the granularity of data for clinical analysis and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What should be documented to support the use of R19.03?

Documentation should include the size, location, and characteristics of the mass, associated symptoms, and any diagnostic imaging results.