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R86.9 ICD-10-CM Code: Unspecified abnormal finding in specimens from male genital organs

R86.9 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software

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) / Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89)

R86.9

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

Unspecified abnormal finding in specimens from male genital organs

Laboratory test results from male reproductive organ samples show an abnormal finding, but the specific type is not specified.

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
R86Abnormal findings in specimens from male genital organs
R86.9Unspecified abnormal finding in specimens from male genital organs

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for R86.9 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for R86.9 in this effective period.

Related Child Codes

Official
R86.0Abnormal level of enzymes in specimens from male genital organs
R86.1Abnormal level of hormones in specimens from male genital organs
R86.2Abnormal level of other drugs, medicaments and biological substances in specimens from male genital organs
R86.3Abnormal level of substances chiefly nonmedicinal as to source in specimens from male genital organs
R86.4Abnormal immunological findings in specimens from male genital organs

Includes

Official
  • abnormal findings in prostatic secretions
  • abnormal findings in semen, seminal fluid
  • abnormal spermatozoa

Excludes 1

Official
  • azoospermia (N46.0-)
  • oligospermia (N46.1-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for R86.9 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for R86.9 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for R86.9 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
This is the least specific code in the R86 category; use only when the abnormality type cannot be determined
Request clarification from the provider or pathologist when possible to assign a more specific code

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 R86.9 an HCC code?

No. R86.9 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

Code
R86.9
Description
Unspecified abnormal finding in specimens from male genital organs
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

R86.9 is the ICD-10-CM diagnosis code for unspecified abnormal finding in specimens from male genital organs. Laboratory test results from male reproductive organ samples show an abnormal finding, but the specific type is not specified. R86.9 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).

R86.9 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 the least specific code in the R86 category; use only when the abnormality type cannot be determined.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R86.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • This is the least specific code in the R86 category; use only when the abnormality type cannot be determined
  • Request clarification from the provider or pathologist when possible to assign a more specific code

Child Codes

Code Hierarchy

Work R86.9 in HCC Buddy

Open R86.9 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.