ICD-10 Coding for Mass(R19.00, R19.02)
Complete ICD-10-CM coding and documentation guide for Mass. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mass
R19.00-R19.07Primary Range
Intra-abdominal and pelvic swelling, mass and lump
This range covers unspecified and specified locations of intra-abdominal and pelvic masses.
Localized swelling, mass and lump of skin and subcutaneous tissue
This range is used for masses located in the skin and subcutaneous tissue.
Neoplasm of uncertain behavior of other and unspecified sites
This range is used when a mass is suspected to be a neoplasm but not confirmed as benign or malignant.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R19.00 | Unspecified intra-abdominal and pelvic swelling, mass and lump | Use when the mass is located in the abdomen or pelvis but the specific location is not documented. |
|
| R19.02 | Left upper quadrant abdominal swelling, mass and lump | Use when the mass is specifically located in the left upper quadrant of the abdomen. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for unspecified abdominal mass
Essential facts and insights about Mass
Primary ICD-10-CM Codes for mass
Decision Criteria
documentation Criteria
- Document the specific location and characteristics of the mass.
Applicable To
- Unspecified abdominal mass
- Unspecified pelvic mass
Clinical Validation Requirements
- Physical examination indicating a palpable mass
- Imaging studies such as ultrasound or CT scan
Code-Specific Risks
- Risk of under-documentation leading to unspecified coding
- Potential for audit if more specific location is available
Coding Notes
- Ensure documentation specifies the location and characteristics of the mass to avoid unspecified coding.
R19.02 - Left upper quadrant abdominal swelling, mass and lump
Use when the mass is specifically located in the left upper quadrant of the abdomen.
Applicable To
- Mass in left upper quadrant
Excludes
- Neoplasm of uncertain behavior (D48.-)
Clinical Validation Requirements
- Physical examination confirming mass in left upper quadrant
- Imaging studies such as ultrasound or CT scan
Coding Notes
Ensure documentation specifies the exact quadrant of the mass.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other abnormal tumor markers
R97.8Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Mass to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R19.00.
Impact
Clinical: May affect treatment decisions, Regulatory: Increases risk of non-compliance, Financial: Potential for reduced reimbursement
Mitigation Strategy
Always measure and record the size of the mass, Use imaging reports to verify size
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Increases risk of audit due to lack of specificity, Data Quality: Decreases accuracy of clinical data
Mitigation Strategy
Review documentation for specific location details and use the appropriate specific code.
Impact
High audit risk for using unspecified codes when specific codes are available.
Mitigation Strategy
Ensure documentation supports the most specific code possible.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Mass, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mass
Use these documentation templates to ensure complete and accurate documentation for Mass. These templates include all required elements for proper coding and billing.
Abdominal mass evaluation
Specialty: GastroenterologyRequired Elements
- Location of the mass
- Size and consistency
- Imaging results
- Associated symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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