R10.819 ICD-10-CM Code: Abdominal tenderness, unspecified site
HCC Buddy Code Card
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FY 2026 Apr update / Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) / Symptoms and signs involving the digestive system and abdomen (R10-R19)
R10.819
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAbdominal tenderness, unspecified site
Tenderness in the abdomen when touched or pressed, but the specific location is not documented or identified.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Abdominal tenderness NOS
Excludes 2
Official- pain localized to other parts of lower abdomen (R10.3-)
- pain localized to upper abdomen (R10.1-)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for R10.819 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for R10.819 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for R10.819 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for R10.819 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for R10.819 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is R10.819 an HCC code?
No. R10.819 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- R10.819
- Description
- Abdominal tenderness, unspecified site
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
R10.819 is the ICD-10-CM diagnosis code for abdominal tenderness, unspecified site. Tenderness in the abdomen when touched or pressed, but the specific location is not documented or identified. R10.819 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering symptoms and signs involving the digestive system and abdomen (r10-r19).
R10.819 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This is a default code when abdominal tenderness is present but location is unclear or not specified.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R10.819 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code when abdominal tenderness is present but location is unclear or not specified
- •Attempt to obtain more specific location information from the provider before defaulting to this code