CPT (Current Procedural Terminology) codes are five-digit numeric codes used to describe medical, surgical, and diagnostic services. They are maintained by the American Medical Association and used by healthcare providers, insurers, and Medicare for billing and reimbursement.

What is the difference between facility and non-facility rates?

Non-facility (office) rates are what Medicare pays when a service is performed in a physician's office. Facility rates are lower because when a service is performed in a hospital or ambulatory surgery center, the facility bills separately for overhead costs like equipment and supplies.

RVU stands for Relative Value Unit. Medicare uses RVUs to measure the value of physician services based on three components: physician work, practice expense, and malpractice cost. Total RVUs are multiplied by the conversion factor ($33.40 in 2026) to calculate the Medicare payment amount.

Is R19.04 a billable ICD-10-CM code?

Yes. R19.04 (Left lower quadrant abdominal swelling, mass and lump) is a billable/specific ICD-10-CM code and can be reported on a claim when the documentation supports it.

ICD-10-CM · R00–R99Billable

ICD-10-CM Code R19.04

Left lower quadrant abdominal swelling, mass and lump

Source: CMS ICD-10-CM FY2026Effective October 1, 2025Reviewed by the D3rx Clinical Billing Team

Diagnosis information

Billable

Yes

Valid for claim submission

Chapter

R00–R99

Symptoms, signs and abnormal clinical findings

Risk adjustment

None

Not risk-adjustable (V28)

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More codes in the R19 category

Other billable ICD-10-CM codes in the same category as R19.04. Coding to the highest specificity the documentation supports is what keeps a claim clean — pick the child code that most precisely matches the diagnosis.

R19.00Intra-abdominal and pelvic swelling, mass and lump, unspecified site
R19.01Right upper quadrant abdominal swelling, mass and lump
R19.02Left upper quadrant abdominal swelling, mass and lump
R19.03Right lower quadrant abdominal swelling, mass and lump
R19.05Periumbilic swelling, mass or lump
R19.06Epigastric swelling, mass or lump
R19.07Generalized intra-abdominal and pelvic swelling, mass and lump
R19.09Other intra-abdominal and pelvic swelling, mass and lump
R19.11Absent bowel sounds
R19.12Hyperactive bowel sounds
R19.15Other abnormal bowel sounds
R19.2Visible peristalsis

Documentation & coding notes

R19.04 is a billable/specific ICD-10-CM code — it can be reported as a primary or secondary diagnosis when the documentation supports it. Code to the highest level of specificity the record allows.
R19.04 specifies laterality. Confirm the documented side matches the code — a laterality mismatch between the note and the claim is a frequent denial and audit target.
R19.04 is a symptom/sign code. Under the ICD-10-CM Official Guidelines, a symptom that is integral to a confirmed condition is not coded separately — report R19.04 when no definitive diagnosis is established, or alongside a confirmed diagnosis only when the symptom is not routinely associated with it.
Always verify the code against the current ICD-10-CM Official Guidelines and the payer's coverage policy before submitting — coverage, medical necessity edits, and sequencing rules vary by payer.

Related R00–R99 codes

R51.9 R07.9 R73.03 R10.9 R05.9 R53.83 R19.7

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Medical coding disclaimer

ICD-10-CM codes and descriptions shown are from the CMS FY2026 official code set and HCC mappings from the CMS-HCC V28 model (payment year 2026), shown for educational reference. Official Guidelines, payer coverage, medical-necessity edits, and sequencing rules vary. Always verify with the current ICD-10-CM Official Guidelines and the payer before submitting claims. D3rx is not responsible for coding or billing outcomes.