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R85.0 ICD-10-CM Code: Abnormal level of enzymes in specimens from digestive organs and abdominal cavity

R85.0 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools

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FY 2026 Apr update / Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) / Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89)

R85.0

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

Abnormal level of enzymes in specimens from digestive organs and abdominal cavity

Test results from digestive organ or abdominal cavity samples show abnormal enzyme levels.

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
R85Abnormal findings in specimens from digestive organs and abdominal cavity
R85.0Abnormal level of enzymes in specimens from digestive organs and abdominal cavity

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for R85.0 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for R85.0 in this effective period.

Related Child Codes

Official
R85.1Abnormal level of hormones in specimens from digestive organs and abdominal cavity
R85.2Abnormal level of other drugs, medicaments and biological substances in specimens from digestive organs and abdominal cavity
R85.3Abnormal level of substances chiefly nonmedicinal as to source in specimens from digestive organs and abdominal cavity
R85.4Abnormal immunological findings in specimens from digestive organs and abdominal cavity
R85.5Abnormal microbiological findings in specimens from digestive organs and abdominal cavity

Includes

Official
  • abnormal findings in peritoneal fluid
  • abnormal findings in saliva

Excludes 1

Official
  • cloudy peritoneal dialysis effluent (R88.0)
  • fecal abnormalities (R19.5)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for R85.0 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for R85.0 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for R85.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Apply when laboratory analysis of abdominal specimens detects unexpected enzyme concentrations
Specify which enzyme is abnormal (e.g., amylase, lipase) when documented

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 R85.0 an HCC code?

No. R85.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

Code
R85.0
Description
Abnormal level of enzymes in specimens from digestive organs and abdominal cavity
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

R85.0 is the ICD-10-CM diagnosis code for abnormal level of enzymes in specimens from digestive organs and abdominal cavity. Test results from digestive organ or abdominal cavity samples show abnormal enzyme levels. R85.0 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 abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (r83-r89).

R85.0 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.

Apply when laboratory analysis of abdominal specimens detects unexpected enzyme concentrations.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R85.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • Apply when laboratory analysis of abdominal specimens detects unexpected enzyme concentrations
  • Specify which enzyme is abnormal (e.g., amylase, lipase) when documented

Child Codes

Code Hierarchy

Work R85.0 in HCC Buddy

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