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

 R40.2A

Nontraumatic coma due to underlying condition

Secondary coma

Code first underlying condition

 R40.3

Persistent vegetative state

 R40.4

Transient alteration of awareness