R16.1 — Splenomegaly, not elsewhere classified
Is R16.1 billable?
Yes, but R16.1 is an unspecified code. R16.1 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, R16.1 is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting R16.1 — the more specific alternatives are listed below.
More specific alternatives
R16.1 at a glance
| Code | R16.1 |
|---|---|
| Description | Splenomegaly, not elsewhere classified |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
Which MS-DRGs does R16.1 group to?
R16.1 sits in MDC 16 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 814Reticuloendothelial and Immunity Disorders with MCCmedical
- 815Reticuloendothelial and Immunity Disorders with CCmedical
- 816Reticuloendothelial and Immunity Disorders without CC/MCCmedical
How is R16.1 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to R16.1. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Débove's disease (splenomegaly)
- Splenomegaly, splenomegalia (Bengal) (cryptogenic) (idiopathic) (tropical)
- Disease, diseased › Débove's
- Mass › splenic
Inclusion terms
Alternative wording in documentation that is classified to R16.1.
- Splenomegaly NOS
Excludes2 — not included here — inherited from Chapter 18
The conditions below are not part of R16.1, but a patient may have both at the same time. When documentation supports it, R16.1 and the excluded code may both be reported.
Excludes2 — not included here — inherited from R10-R19
The conditions below are not part of R16.1, but a patient may have both at the same time. When documentation supports it, R16.1 and the excluded code may both be reported.
- congenital or infantile pylorospasm (Q40.0)
- gastrointestinal hemorrhage (K92.0-K92.2)
- intestinal obstruction (K56.-)
- newborn gastrointestinal hemorrhage (P54.0-P54.3)
- newborn intestinal obstruction (P76.-)
- pylorospasm (K31.3)
- signs and symptoms involving the urinary system (R30-R39)
- symptoms referable to female genital organs (N94.-)
- symptoms referable to male genital organs (N48-N50)
How long has R16.1 existed?
R16.1 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.
Which codes are confused with R16.1?
ICD-10-CM declares these codes mutually exclusive with R16.1 — exactly one of each pair can be correct for a given encounter.