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R19.03 ICD-10-CM Code: Right lower quadrant abdominal swelling, mass and lump

ICD-10-CM Code View

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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)

R19.03

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Right lower quadrant abdominal swelling, mass and lump

A swelling, mass, or lump detected in the right lower portion of the abdomen, typically where the appendix and right colon are located.

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

Official
R19Other symptoms and signs involving the digestive system and abdomen
R19.0Intra-abdominal and pelvic swelling, mass and lump
R19.03Right lower quadrant abdominal swelling, mass and lump

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for R19.03 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for R19.03 in this effective period.

Related Child Codes

Official
R19.00Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01Right upper quadrant abdominal swelling, mass and lump
R19.02Left upper quadrant abdominal swelling, mass and lump
R19.04Left lower quadrant abdominal swelling, mass and lump
R19.05Periumbilic swelling, mass or lump

Includes

Official

ICD-10-CM does not list Includes notes for R19.03 in this effective period.

Excludes 1

Official
  • abdominal distension (gaseous) (R14.-)
  • ascites (R18.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for R19.03 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for R19.03 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for R19.03 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Document the specific right lower quadrant location in the medical record
Consider differential diagnoses common to this region (appendicitis, inguinal hernia, ovarian pathology in females)

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is R19.03 an HCC code?

No. R19.03 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

Code
R19.03
Description
Right lower quadrant abdominal swelling, mass and lump
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

R19.03 is the ICD-10-CM diagnosis code for right lower quadrant abdominal swelling, mass and lump. A swelling, mass, or lump detected in the right lower portion of the abdomen, typically where the appendix and right colon are located. R19.03 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).

R19.03 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.

Document the specific right lower quadrant location in the medical record.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R19.03 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • Document the specific right lower quadrant location in the medical record
  • Consider differential diagnoses common to this region (appendicitis, inguinal hernia, ovarian pathology in females)

Child Codes

Code Hierarchy

Work R19.03 in HCC Buddy

Open R19.03 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.