FY2027
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Excludes1 pair

R04.2 vs R09.3

R04.2 and R09.3 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

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 (amount) (color) (odor)
  • Excess, excessive, excessively › sputum
  • Sputum › abnormal (amount) (color) (odor) (purulent)
  • Sputum › excessive (cause unknown)
  • 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