Category: R40 - Somnolence, stupor and coma

 Chapter Notes

 Section Notes

 R40

Somnolence, stupor and coma

neonatal coma (P91.5)

somnolence, stupor and coma in diabetes (E08-E13)

somnolence, stupor and coma in hepatic failure (K72.-)

somnolence, stupor and coma in hypoglycemia (nondiabetic) (E15)

 R40.0

Somnolence

Drowsiness

coma (R40.2-)

 R40.1

Stupor

Catatonic stupor

Semicoma

catatonic schizophrenia (F20.2)

coma (R40.2-)

depressive stupor (F31-F33)

dissociative stupor (F44.2)

manic stupor (F30.2)

 R40.2

Coma

Code first any associated:

fracture of skull (S02.-)

intracranial injury (S06.-)

One code from each subcategory, R40.21-R40.23, is required to complete the coma scale

 R40.20

Unspecified coma

Coma NOS

Unconsciousness NOS

 R40.21

Coma scale, eyes open

The following appropriate 7th character is to be added to subcategory R40.21-:

0

unspecified time

1

in the field [EMT or ambulance]

2

at arrival to emergency department

3

at hospital admission

4

24 hours or more after hospital admission

 R40.211

Coma scale, eyes open, never

Coma scale eye opening score of 1

 R40.212

Coma scale, eyes open, to pain

Coma scale eye opening score of 2

 R40.213

Coma scale, eyes open, to sound

Coma scale eye opening score of 3

 R40.214

Coma scale, eyes open, spontaneous

Coma scale eye opening score of 4

 R40.22

Coma scale, best verbal response

The following appropriate 7th character is to be added to subcategory R40.22-:

0

unspecified time

1

in the field [EMT or ambulance]

2

at arrival to emergency department

3

at hospital admission

4

24 hours or more after hospital admission

 R40.221

Coma scale, best verbal response, none

Coma scale verbal score of 1

 R40.222

Coma scale, best verbal response, incomprehensible words

Coma scale verbal score of 2

Incomprehensible sounds (2-5 years of age)

Moans/grunts to pain; restless (< 2 years old)

 R40.223

Coma scale, best verbal response, inappropriate words

Coma scale verbal score of 3

Inappropriate crying or screaming (< 2 years of age)

Screaming (2-5 years of age)

 R40.224

Coma scale, best verbal response, confused conversation

Coma scale verbal score of 4

Inappropriate words (2-5 years of age)

Irritable cries (< 2 years of age)

 R40.225

Coma scale, best verbal response, oriented

Coma scale verbal score of 5

Cooing or babbling or crying appropriately (< 2 years of age)

Uses appropriate words (2- 5 years of age)

 R40.23

Coma scale, best motor response

The following appropriate 7th character is to be added to subcategory R40.23-:

0

unspecified time

1

in the field [EMT or ambulance]

2

at arrival to emergency department

3

at hospital admission

4

24 hours or more after hospital admission

 R40.231

Coma scale, best motor response, none

Coma scale motor score of 1

 R40.232

Coma scale, best motor response, extension

Abnormal extensor posturing to pain or noxious stimuli (< 2 years of age)

Coma scale motor score of 2

Extensor posturing to pain or noxious stimuli (2-5 years of age)

 R40.233

Coma scale, best motor response, abnormal flexion

Abnormal flexure posturing to pain or noxious stimuli (2-5 years of age)

Coma scale motor score of 3

Flexion/decorticate posturing (< 2 years of age)

 R40.234

Coma scale, best motor response, flexion withdrawal

Coma scale motor score of 4

Withdraws from pain or noxious stimuli (2-5 years of age)

 R40.235

Coma scale, best motor response, localizes pain

Coma scale motor score of 5

Localizes pain (2-5 years of age)

Withdraws to touch (< 2 years of age)

 R40.236

Coma scale, best motor response, obeys commands

Coma scale motor score of 6

Normal or spontaneous movement (< 2 years of age)

Obeys commands (2-5 years of age)

 R40.24

Glasgow coma scale, total score

Assign a code from subcategory R40.24, when only the total coma score is documented

The following appropriate 7th character is to be added to subcategory R40.24-:

0

unspecified time

1

in the field [EMT or ambulance]

2

at arrival to emergency department

3

at hospital admission

4

24 hours or more after hospital admission

 R40.241

Glasgow coma scale score 13-15

 R40.242

Glasgow coma scale score 9-12

 R40.243

Glasgow coma scale score 3-8

 R40.244

Other coma, without documented Glasgow coma scale score, or with partial score reported

 R40.3

Persistent vegetative state

 R40.4

Transient alteration of awareness