ICD-10-CM Book 2024 Edition

Chapters  /  Chapter 18  /  R40-R46  /  R40
R40 Somnolence, stupor and coma
Excludes1 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
Excludes1 coma (R40.2-)
R40.1 Stupor
Catatonic stupor
Semicoma
Excludes1 catatonic schizophrenia (F20.2)
coma (R40.2-)
depressive stupor (F31-F33)
dissociative stupor (F44.2)
manic stupor (F30.2)
R40.2 Coma
CodeFirst any associated:
fracture of skull (S02.-)
intracranial injury (S06.-)
Notes 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
char7Note The following appropriate 7th character is to be added to subcategory R40.21-:
char7Def 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
char7Note The following appropriate 7th character is to be added to subcategory R40.22-:
char7Def 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
char7Note The following appropriate 7th character is to be added to subcategory R40.23-:
char7Def 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
Notes Assign a code from subcategory R40.24, when only the total coma score is documented
char7Note The following appropriate 7th character is to be added to subcategory R40.24-:
char7Def 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
CodeFirst underlying condition
R40.3 Persistent vegetative state
R40.4 Transient alteration of awareness