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ICD-10 Guide
ICD-10 CodesR19.07

R19.07

Generalized intra-abdominal and pelvic swelling, mass and lump

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

Code Description

ICD-10 R19.07 is a billable code used to indicate a diagnosis of generalized intra-abdominal and pelvic swelling, mass and lump.

Key Diagnostic Point:

R19.07 refers to generalized intra-abdominal and pelvic swelling, mass, and lump, which can manifest as a palpable mass or swelling in the abdominal or pelvic region. This condition may arise from various underlying causes, including fluid accumulation (ascites), tumors (benign or malignant), organ enlargement (hepatomegaly, splenomegaly), or lymphadenopathy. Patients may present with symptoms such as abdominal pain, discomfort, changes in bowel habits, or urinary symptoms, depending on the underlying etiology. Clinical evaluation often includes physical examination, imaging studies (ultrasound, CT scan), and laboratory tests to identify the cause of the swelling. Accurate diagnosis is crucial, as the management will vary significantly based on the underlying condition. This code is used when the specific cause of the swelling is not classified elsewhere, making it essential for coders to ensure thorough documentation of clinical findings and diagnostic workup.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes
  • Need for comprehensive diagnostic workup
  • Differentiation from other abdominal/pelvic conditions
  • Documentation of clinical findings and imaging results

Audit Risk Factors

  • Insufficient documentation of clinical findings
  • Failure to specify the underlying cause when known
  • Inconsistent coding with imaging or lab results
  • Misuse of the code for conditions that have specific codes

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history and physical examination findings, imaging results, and laboratory tests must be documented to support the diagnosis.

Common Clinical Scenarios

Patients presenting with unexplained abdominal swelling, requiring evaluation for ascites, tumors, or organ enlargement.

Billing Considerations

Ensure that all relevant diagnostic tests are documented, and consider the patient's history for potential underlying conditions.

Emergency Medicine

Documentation Requirements

Acute care documentation must include the patient's presenting symptoms, vital signs, and any immediate interventions performed.

Common Clinical Scenarios

Patients presenting with acute abdominal pain and swelling, necessitating rapid assessment and imaging.

Billing Considerations

Document the urgency of the situation and any immediate findings that may indicate a surgical emergency.

Coding Guidelines

Inclusion Criteria

Use R19.07 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the swelling, mass, or lump is not classified elsewhere
  • Document the clinical findings and any diagnostic tests performed to support the use of this code

Exclusion Criteria

Do NOT use R19.07 When
No specific exclusions found.

Related CPT Codes

76700CPT Code

Ultrasound, abdominal, complete

Clinical Scenario

Used to evaluate abdominal swelling or masses.

Documentation Requirements

Document the indication for the ultrasound and findings.

Specialty Considerations

Ensure that the ultrasound report correlates with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of symptoms and signs, including generalized abdominal and pelvic swelling, which aids in better tracking of patient outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of symptoms and signs, including generalized abdominal and pelvic swelling, which aids in better tracking of patient outcomes and resource utilization.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of symptoms and signs, including generalized abdominal and pelvic swelling, which aids in better tracking of patient outcomes and resource utilization.

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

When should I use R19.07?

Use R19.07 when a patient presents with generalized abdominal or pelvic swelling, and the specific cause is not classified elsewhere. Ensure thorough documentation of clinical findings and diagnostic workup.