R04.2 vs R09.3
R04.2 and R09.3 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on R09.3
blood-stained sputum (R04.2)
R04.2
Hemoptysis
Billable
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R00-R09
Use when the record says
- Blood-stained sputum
- Cough with hemorrhage
Indexed under
- Hemoptysis
- Sputum › blood-stained
R09.3
Abnormal sputum
Billable
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R00-R09
Use when the record says
- Abnormal amount of sputum
- Abnormal color of sputum
- Abnormal odor of sputum
- Excessive sputum
Indexed under
- Abnormal, abnormality, abnormalities › sputum
- Excess, excessive, excessively › sputum
- Sputum › abnormal
- Sputum › excessive
- Excess, excessive, excessively › secretion › sputum
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027