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ICD-10 Guide
ICD-10 CodesR19.01

R19.01

Right upper quadrant abdominal swelling, mass and lump

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

Code Description

ICD-10 R19.01 is a billable code used to indicate a diagnosis of right upper quadrant abdominal swelling, mass and lump.

Key Diagnostic Point:

R19.01 refers to the clinical finding of swelling, mass, or lump specifically located in the right upper quadrant (RUQ) of the abdomen. This area encompasses the liver, gallbladder, right kidney, and portions of the small and large intestines. The presence of a mass or swelling can indicate a variety of underlying conditions, including benign tumors, cysts, or more serious pathologies such as malignancies or infections. Symptoms accompanying RUQ swelling may include pain, tenderness, jaundice, or changes in bowel habits. Clinical evaluation often involves physical examination, imaging studies such as ultrasound or CT scans, and laboratory tests to assess liver function and rule out infections. Accurate diagnosis is crucial, as the management and treatment options vary significantly based on the underlying cause of the mass or swelling.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes (benign vs malignant)
  • Need for comprehensive diagnostic workup
  • Differentiation from other abdominal masses
  • Documentation of associated symptoms

Audit Risk Factors

  • Inadequate documentation of the clinical findings
  • Failure to specify the nature of the mass (benign vs malignant)
  • Lack of supporting imaging or lab results
  • Misuse of related codes leading to upcoding or downcoding

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Thorough documentation of patient history, physical examination findings, and any imaging or lab results that support the diagnosis.

Common Clinical Scenarios

Patients presenting with RUQ pain and swelling, often requiring further evaluation for liver disease or gallbladder pathology.

Billing Considerations

Consideration of chronic conditions such as liver cirrhosis or gallstones that may contribute to RUQ masses.

Emergency Medicine

Documentation Requirements

Detailed acute care documentation including vital signs, pain assessment, and immediate interventions.

Common Clinical Scenarios

Patients with acute RUQ pain and swelling, potentially indicating acute cholecystitis or liver abscess.

Billing Considerations

Rapid assessment and documentation are crucial for timely intervention and management.

Coding Guidelines

Inclusion Criteria

Use R19.01 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is supported by clinical documentation and that the mass is specifically located in the right upper quadrant

Exclusion Criteria

Do NOT use R19.01 When
No specific exclusions found.

Related CPT Codes

76700CPT Code

Ultrasound, abdomen, complete

Clinical Scenario

Used to evaluate RUQ swelling or mass.

Documentation Requirements

Document indication for ultrasound and findings.

Specialty Considerations

Ensure that the ultrasound report correlates with the clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of abdominal masses, improving the granularity of data for clinical research and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of abdominal masses, improving the granularity of data for clinical research 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 documentation is needed to support the use of R19.01?

Documentation should include a detailed description of the mass or swelling, associated symptoms, results of imaging studies, and any relevant laboratory findings.