R85.9
BillableUnspecified abnormal finding in specimens from digestive organs and abdominal cavity
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R85.9 an HCC code?
No. R85.9 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
R85.9 is the ICD-10-CM diagnosis code for unspecified abnormal finding in specimens from digestive organs and abdominal cavity. A tissue sample from the digestive system or abdominal area shows an abnormal result, but the specific type of abnormality is not specified. R85.9 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).
R85.9 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 catch-all code; query the provider for more specific findings whenever possible to improve coding accuracy.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R85.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a catch-all code; query the provider for more specific findings whenever possible to improve coding accuracy
- •Use only when the pathology report does not provide sufficient detail for more specific coding