R40.1 vs R46.4
R40.1 and R46.4 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 R46.4
stupor (R40.1)
R40.1
Stupor
Billable
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R40-R46
Use when the record says
- Catatonic stupor
- Semicoma
Indexed under
- Clouded state
- Semicoma
- Stupor (catatonic)
- Catatonic › stupor
R46.4
Slowness and poor responsiveness
Billable
- Chapter 18
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
- Section
- R40-R46
Indexed under
- Behavior › poor responsiveness
- Behavior › slowness
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