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R16.1 ICD-10-CM Code: Splenomegaly, not elsewhere classified

Compare with another code for R16.1Check this code on a claim

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 9 Excludes2

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Excludes2from R10-R19Not included here; may be reported together
  • congenital or infantile pylorospasm (Q40.0)
  • gastrointestinal hemorrhage (K92.0-K92.2)
  • intestinal obstruction (K56.-)
  • newborn gastrointestinal hemorrhage (P54.0-P54.3)

+5 more in Instructions

IncludesWhat this code covers
  • Splenomegaly NOS

Where it sits Source: CMS/NCHS

Under:Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere ClassifiedR10-R19 Symptoms and signs involving the digestive system and abdomenR16 Hepatomegaly and splenomegaly, not elsewhere classified

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 814 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC (MDC 16)
  • MS-DRG 815 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC (MDC 16)
  • MS-DRG 816 — RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC (MDC 16)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R16.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on R16.1 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Splenomegaly NOS

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from R10-R19

Coder workflow for R16.1

MedCoder structured workflow — derived from this code’s own official record

Before you code R16.1

  1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

    Guide: Symptom code vs confirmed diagnosis →

  2. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on R16.1; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

Choose the right path

  1. Is an established diagnosis that explains this sign or symptom documented?
    Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
    No → Continue — the sign or symptom code stands when no definitive diagnosis is established.

Consider R16.1. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Any detail beyond this code’s title
What the record states that a more specific code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of R16.1(9 notes)

    Coding workflow: The conditions named in this note are not included in R16.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareQ40.0, K56, P76, K31.3, N94

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The sign or symptom is documented, and the same record establishes a diagnosis that routinely includes it.

Coding question: Is R16.1 reported in addition to the diagnosis?

Path: Review the documented diagnosis and whether the classification treats this finding as integral to it.

Reason: Signs and symptoms integral to a confirmed diagnosis are not coded separately; those not routinely associated with it may be reported when present (Guidelines I.B.5, I.B.6, I.C.18.b).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse R16.1 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of R16.1 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • Q40.0— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of congenital or infantile pylorospasm adds Q40.0; it is not part of this code and both may be reported when both are documented.

    Full comparison: R16.1 vs Q40.0 →

  • K92.0— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of gastrointestinal hemorrhage adds K92.0; it is not part of this code and both may be reported when both are documented.

    Full comparison: R16.1 vs K92.0 →

  • K92.2— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of gastrointestinal hemorrhage adds K92.2; it is not part of this code and both may be reported when both are documented.

    Full comparison: R16.1 vs K92.2 →

  • K56— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of intestinal obstruction adds K56; it is not part of this code and both may be reported when both are documented.

    Full comparison: R16.1 vs K56 →

  • P54.0— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of newborn gastrointestinal hemorrhage adds P54.0; it is not part of this code and both may be reported when both are documented.

    Full comparison: R16.1 vs P54.0 →

  • P54.3— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of newborn gastrointestinal hemorrhage adds P54.3; it is not part of this code and both may be reported when both are documented.

    Full comparison: R16.1 vs P54.3 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Splenomegaly, not elsewhere classified is a billable ICD-10-CM diagnosis code (R16.1).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name R16.1 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: D73.1 — Hypersplenism.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 3 MS-DRGs: DRG 814 (MDC 16), DRG 815 (MDC 16), DRG 816 (MDC 16).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SYM006 — Abdominal pain and other digestive/abdomen signs and symptoms (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Abdominal pain and other digestive/abdomen signs and symptoms).

R13.0 — Aphagia, R14.0 — Abdominal distension (gaseous), R14.1 — Gas pain, R14.2 — Eructation, R14.3 — Flatulence, R15.0 — Incomplete defecation, R15.1 — Fecal smearing, R15.2 — Fecal urgency, R15.9 — Full incontinence of feces, R16.0 — Hepatomegaly, not elsewhere classified, R16.2 — Hepatomegaly with splenomegaly, not elsewhere classified, R17 — Unspecified jaundice, R18.0 — Malignant ascites, R18.8 — Other ascites, R19.00 — Intra-abdominal and pelvic swelling, mass and lump, unspecified site, R19.01 — Right upper quadrant abdominal swelling, mass and lump, R19.02 — Left upper quadrant abdominal swelling, mass and lump, R19.03 — Right lower quadrant abdominal swelling, mass and lump, R19.04 — Left lower quadrant abdominal swelling, mass and lump, R19.05 — Periumbilic swelling, mass or lump, +58 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Mass”, “Splenomegaly, splenomegalia”; these codes share that main term but sit in a different category of the Tabular List.

A52.79 — Other symptomatic late syphilis (syphilitic), B54 — Unspecified malaria (malarial), B65.1 — Schistosomiasis due to Schistosoma mansoni [intestinal schistosomiasis] (Egyptian), D73.2 — Chronic congestive splenomegaly (cirrhotic), D73.81 — Neutropenic splenomegaly (neutropenic), E75.22 — Gaucher disease (Gaucher's), H93.8 — Other specified disorders of ear (ear), N28.89 — Other specified disorders of kidney and ureter (kidney), N63.0 — Unspecified lump in unspecified breast (breast), Q89.09 — Congenital malformations of spleen (congenital), R19.00 — Intra-abdominal and pelvic swelling, mass and lump, unspecified site (abdominal), R19.01 — Right upper quadrant abdominal swelling, mass and lump (abdominal, right upper quadrant), R19.02 — Left upper quadrant abdominal swelling, mass and lump (abdominal, left upper quadrant), R19.03 — Right lower quadrant abdominal swelling, mass and lump (abdominal, right lower quadrant), R19.04 — Left lower quadrant abdominal swelling, mass and lump (abdominal, left lower quadrant), R19.05 — Periumbilic swelling, mass or lump (abdominal, periumbilic), R19.06 — Epigastric swelling, mass or lump (abdominal, epigastric), R19.07 — Generalized intra-abdominal and pelvic swelling, mass and lump (abdominal, generalized), R19.09 — Other intra-abdominal and pelvic swelling, mass and lump (umbilical), R22.0 — Localized swelling, mass and lump, head (head), +7 more

Contextual Map

Every relationship of R16.1 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run R16.1 with this related code in Claim Check

Hierarchy

Referenced by Excludes1 notes

  • D73.1 — Hypersplenism[Excludes1]: “splenomegaly NOS (R16.1)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 16 — Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders[MDC crossing]: “Diseases and Disorders of Blood, Blood Forming Organs and Immunologic Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,615 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Débove's disease (splenomegaly)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Disease, diseased, Débove's (splenomegaly)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Mass, splenic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Splenomegaly, splenomegalia (Bengal) (cryptogenic) (idiopathic) (tropical)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (4)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "R16.1 — Splenomegaly, not elsewhere classified." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/r16.1-splenomegaly-not-elsewhere-classified

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Splenomegaly, not elsewhere classified

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R16.1 in its code family, with their registry titles.

View all codes in the R16 family