R19.04
BillableLeft lower quadrant abdominal swelling, mass and lump
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R19.04 an HCC code?
No. R19.04 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
R19.04 is the ICD-10-CM diagnosis code for left lower quadrant abdominal swelling, mass and lump. A swelling, mass, or lump detected in the left lower portion of the abdomen, typically where the left colon and sigmoid are located. R19.04 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).
R19.04 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.
Ensure documentation clearly indicates left lower quadrant location.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R19.04 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation clearly indicates left lower quadrant location
- •Consider common pathologies in this region such as diverticulitis or left-sided ovarian conditions