Excludes1 pair
R07.0 vs R52
R07.0 and R52 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 R52
throat pain (R07.0)
R07.0
Pain in throat
Billable
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R00-R09
Indexed under
- Pain › laryngeal
- Pain › throat
R52
Pain, unspecified
BillableUnspecified
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R50-R69
Use when the record says
- Acute pain NOS
- Generalized pain NOS
- Pain NOS
Indexed under
- Pain (s)
- Pain › acute
- Pain › generalized NOS
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