ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 R19.5

Billable / Specific

Other fecal abnormalities

R19
Block
5
Synonyms
786
LCDs
22
Payer Policies
4
Linked CPTs

About ICD-10-CM R19.5

ICD-10-CM code R19.5 represents Other fecal abnormalities. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R19). The 2026 edition of ICD-10-CM R19.5 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under R19.5. Per CMS ICD-10-CM Tabular 2026.

  • Abnormal stool color
  • Bulky stools
  • Mucus in stools
  • Occult blood in feces
  • Occult blood in stools

Type 1 Excludes

Pure excludes, these codes can never be coded together with R19.5. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • melena (K92.1)
  • neonatal melena (P54.1)

Medicare LCD Coverage for R19.5

Local Coverage Determinations (LCDs) from CMS MACs that list R19.5 as a covered diagnosis.

786 LCDs

Showing top 10 of 786 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Colon Capsule Endoscopy (CCE)
Article ID: 58471, Effective: 2023-02-23 00:00:00, 6 covered, 0 non-covered
CPT 91113 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 45398 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 44392 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 45386 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 45378 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 44390 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 45393 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 44394 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 44401 →
CMS LCD: Billing and Coding: Diagnostic Colonoscopy
Article ID: 55937, Effective: 2026-02-04 00:00:00, 244 covered, 1 non-covered
CPT 44407 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing R19.5.

22 policies

5 Medicare

Billing and Coding: Diagnostic Colonoscopy
Policy ID: ART-55937
Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic
Policy ID: ART-56394
Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Policy ID: ART-56456
Billing and Coding: Endoscopy by Capsule
Policy ID: ART-56461
Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
Policy ID: ART-56632

CPT Codes Commonly Billed with R19.5

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

4 linkages
  • 45378 Diagnostic colonoscopy — colorectal screening, family hx colon cancer, polyp, melena, iron def anemia, diverticulosis, ulcerative colitis, Crohn, occult blood, rectal polyp, weight loss, IBS Gastroenterology
  • 45380 Colonoscopy with biopsy — colon polyp, neoplasm of colon, melena, iron deficiency anemia, screening, personal hx polyps, UC, occult blood Gastroenterology
  • 45381 Colonoscopy with directed submucosal injection — polyp removal facilitation, same dx as polypectomy Gastroenterology
  • 91113 CMS LCD: Billing and Coding: Colon Capsule Endoscopy (CCE) CMS LCD

Convert R19.5 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
R19.5 7877 10000
R19.5 7921 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 R19.5, Billing FAQ

Is ICD-10 code R19.5 billable? +

Yes, R19.5 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to R19.5? +

ICD-10 R19.5 includes: Abnormal stool color; Bulky stools; Mucus in stools, and 2 more clinical synonyms.

What codes are Type 1 Excludes for R19.5? +

Type 1 Excludes (never code together with R19.5): melena (K92.1); neonatal melena (P54.1)

What CPT codes are commonly billed with R19.5? +

Procedures frequently paired with R19.5 include: 45378, 45380, 45381, 91113.

What ICD-9 codes does R19.5 map to? +

Per CMS GEMs, R19.5 maps to ICD-9 codes: 7877, 7921. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on June 1, 2026.

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