Is ICD-10-CM code R16 billable?

No, R16 (Hepatomegaly and splenomegaly, not elsewhere classified) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code R16 belong to?

R16 belongs to Chapter 18 of the ICD-10-CM tabular list: R00–R99 (Symptoms, Signs and Abnormal Clinical and Laboratory Findings).

R16Not billable, use a more specific code below

Hepatomegaly and splenomegaly, not elsewhere classified

In Symptoms and signs involving the digestive system and abdomen (R10-R19), chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings

3 billable codes under R16: none are a CC or MCC; none map to an HCC.

Instructional notes

Also applies, from Symptoms and signs involving the digestive system and abdomen (R10-R19)

These notes sit on R10-R19 and apply to every code under it, including R16.

Excludes2: not included here, code separately if applicable

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)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers when to report symptom, sign, and abnormal finding codes (R00-R99), plus specific rules for falls, coma scales, non-infectious SIRS, death NOS, and NIHSS scores.

Use of symptom codes (page 75)
Use of a symptom code with a definitive diagnosis code (page 75)
Combination codes that include symptoms (page 75)
Repeated falls (page 76)
Coma (page 76)
Functional quadriplegia (page 76)
SIRS due to Non-Infectious Process (page 77)
Death NOS (page 77)

Read Section I.C.18 (page 75), 1 more topics

All codes under R16

R16 can't be used on a claim. Pick a billable code below; grey headings group them.

R16 MS-DRGs

As the principal diagnosis, the billable codes under R16 group to MS-DRG 441, 442, 443, 814, 815, or 816 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 441 Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis with MCC (2 of 3 codes)
DRG 442 Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis with CC (2 of 3 codes)
DRG 443 Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis without CC/MCC (2 of 3 codes)
DRG 814 Reticuloendothelial and Immunity Disorders with MCC (1 of 3 codes)
DRG 815 Reticuloendothelial and Immunity Disorders with CC (1 of 3 codes)
DRG 816 Reticuloendothelial and Immunity Disorders without CC/MCC (1 of 3 codes)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Liver Diseases

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. There are many kinds of liver diseases:

Spleen Diseases

Your spleen is an organ above your stomach and under your ribs on your left side. It is about as big as your fist. The spleen is part of your lymphatic system, which fights infection and keeps your body fluids in balance. It contains white blood cells that fight germs. Your spleen also helps control the amount of blood in your body, and destroys old and damaged cells.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.