2026 ICD-10-CM Diagnosis Code R16.1Splenomegaly, not elsewhere classified

ICD-10-CM Codes›R00–R99›R10-R19›R16

ICD-10-CM R16.1
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

R16.1 is a billable ICD-10-CM diagnosis code for splenomegaly, not elsewhere classified. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 814 through 816. As a symptom code, it should not be used as a principal diagnosis once a related definitive diagnosis has been established. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Abdominal pain and other digestive/abdomen signs and symptoms.

Code Identity

ICD-10-CM Code
R16.1
Billable Status
Yes — Valid for Submission
Code Describes
Splenomegaly, not elsewhere classified
Short Description
Splenomegaly, not elsewhere classified
Same as the full description in the CMS dataset.
Parent Code
R16
Hepatomegaly and splenomegaly, not elsewhere classified

Code Classification

ChapterR00–R99Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
SectionR10-R19Symptoms and signs involving the digestive system and abdomen
CategoryR16Hepatomegaly and splenomegaly, not elsewhere classified
This CodeR16.1Splenomegaly, not elsewhere classified

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Infection of spleen
  • Mass of spleen
  • Optic nerve edema, splenomegaly syndrome
  • Pain due to enlargement of spleen
  • Schistosomal splenomegaly
  • Spleen palpable
  • Spleen palpable below costal margin
  • Spleen palpable in right lateral position
  • Spleen palpable on inspiration
  • Splenic notch palpable
  • Splenic schistosomal giant cell lymphoma
  • Splenomegaly
  • Splenomegaly co-occurrent with human immunodeficiency virus infection
  • Splenomegaly due to storage disease
  • Tip of spleen palpable

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • Splenomegaly NOS

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Débove's disease(splenomegaly)
    • Disease, diseased
      • Débove's (splenomegaly)
    • Mass
      • splenic
    • Splenomegaly, splenomegalia(Bengal) (cryptogenic) (idiopathic) (tropical)

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR SYM006
Abdominal pain and other digestive/abdomen signs and symptoms
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Gaucher Disease

    an autosomal recessive disorder caused by a deficiency of acid beta-glucosidase (glucosylceramidase) leading to intralysosomal accumulation of glycosylceramide mainly in cells of the mononuclear phagocyte system. the characteristic gaucher cells, glycosphingolipid-filled histiocytes, displace normal cells in bone marrow and visceral organs causing skeletal deterioration, hepatosplenomegaly, and organ dysfunction. there are several subtypes based on the presence and severity of neurological involvement.

  • Idiopathic Noncirrhotic Portal Hypertension

    portal hypertension without known risk factors for hypertension, e.g., hepatic cirrhosis and schistosomiasis. idiopathic noncirrhotic portal hypertension is most often associated with pathology in the portal system vasculature.

  • Splenomegaly

    enlargement of the spleen.

Patient EducationClinical

Spleen Diseases

Your spleen is an organ above your stomach and under your ribs on your left side. It is about as big as your fist. The spleen is part of your lymphatic system, which fights infection and keeps your body fluids in balance. It contains white blood cells that fight germs.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert R16.1 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
789.2 Splenomegaly
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About R16.1Overview

Is R16.1 (Hepatomegaly and splenomegaly, not elsewhere classified) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report splenomegaly, not elsewhere classified on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does R16.1 group to?

When splenomegaly, not elsewhere classified is the principal diagnosis on an inpatient stay, it groups to MS-DRG 814, 815, 816, with relative weights from 0.6320 to 2.1267 depending on complications. Higher weights mean higher Medicare reimbursement.

Can R16.1 be a principal diagnosis?

Use it with care. This is a symptom code, so once a definitive diagnosis explaining the splenomegaly, not elsewhere classified is established, that condition takes the principal position instead.

What is the ICD-9 equivalent of R16.1?

Under the General Equivalence Mappings, splenomegaly, not elsewhere classified converts to ICD-9-CM 789.2 (splenomegaly). The mapping is approximate, so confirm the match fits the documentation.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.