ICD-10 R04.2
Billable / Specific CCHemoptysis
About ICD-10-CM R04.2
ICD-10-CM code R04.2 represents Hemoptysis. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R04). The 2026 edition of ICD-10-CM R04.2 became effective on October 1, 2025.
Coding Tips for R04.2
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
R04.2 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under R04.2. Per CMS ICD-10-CM Tabular 2026.
- Blood-stained sputum
- Cough with hemorrhage
Inpatient DRG Impact, CC
codes Hemoptysis. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for R04.2
Local Coverage Determinations (LCDs) from CMS MACs that list R04.2 as a covered diagnosis.
Showing top 10 of 202 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R04.2.
5 Medicare
2 Aetna
CPT Codes Commonly Billed with R04.2
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert R04.2 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| R04.2 | 78630 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To R04.2
Other codes in section R00-R09 (Symptoms and signs involving the circulatory and respiratory systems).
ICD-10 R04.2, Billing FAQ
Is ICD-10 code R04.2 billable? +
Yes, R04.2 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 R04.2? +
ICD-10 R04.2 includes: Blood-stained sputum; Cough with hemorrhage.
Is R04.2 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does R04.2 map to? +
Per CMS GEMs, R04.2 maps to ICD-9 codes: 78630. 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 July 16, 2026.
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