ICD-10-CM Book 2024 Edition

Chapters  /  Chapter 18  /  R40-R46

Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46)

Excludes2: symptoms and signs constituting part of a pattern of mental disorder (F01-F99)
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
R41 Other symptoms and signs involving cognitive functions and awareness
Excludes1 dissociative [conversion] disorders (F44.-)
mild cognitive impairment of uncertain or unknown etiology (G31.84)
R41.0 Disorientation, unspecified
Confusion NOS
Delirium NOS
R41.1 Anterograde amnesia
R41.2 Retrograde amnesia
R41.3 Other amnesia
Amnesia NOS
Memory loss NOS
Excludes1 amnestic disorder due to known physiologic condition (F04)
amnestic syndrome due to psychoactive substance use (F10-F19 with 5th character .6)
mild memory disturbance due to known physiological condition (F06.8)
transient global amnesia (G45.4)
R41.4 Neurologic neglect syndrome
Asomatognosia
Hemi-akinesia
Hemi-inattention
Hemispatial neglect
Left-sided neglect
Sensory neglect
Visuospatial neglect
Excludes1 visuospatial deficit (R41.842)
R41.8 Other symptoms and signs involving cognitive functions and awareness
R41.81 Age-related cognitive decline
Senility NOS
age Adult: [15-124]
R41.82 Altered mental status, unspecified
Change in mental status NOS
Excludes1 altered level of consciousness (R40.-)
altered mental status due to known condition - code to condition
delirium NOS (R41.0)
R41.83 Borderline intellectual functioning
IQ level 71 to 84
Excludes1 intellectual disabilities (F70-F79)
nonPrimary Yes
R41.84 Other specified cognitive deficit
Excludes1 cognitive deficits as sequelae of cerebrovascular disease (I69.01-, I69.11-, I69.21-, I69.31-, I69.81-, I69.91-)
R41.840 Attention and concentration deficit
Excludes1 attention-deficit hyperactivity disorders (F90.-)
R41.841 Cognitive communication deficit
R41.842 Visuospatial deficit
R41.843 Psychomotor deficit
R41.844 Frontal lobe and executive function deficit
R41.89 Other symptoms and signs involving cognitive functions and awareness
Anosognosia
R41.9 Unspecified symptoms and signs involving cognitive functions and awareness
Unspecified neurocognitive disorder
R42 Dizziness and giddiness
Light-headedness
Vertigo NOS
Excludes1 vertiginous syndromes (H81.-)
vertigo from infrasound (T75.23)
R43 Disturbances of smell and taste
R43.0 Anosmia
R43.1 Parosmia
R43.2 Parageusia
R43.8 Other disturbances of smell and taste
Mixed disturbance of smell and taste
R43.9 Unspecified disturbances of smell and taste
R44 Other symptoms and signs involving general sensations and perceptions
Excludes1 alcoholic hallucinations (F10.151, F10.251, F10.951)
hallucinations in drug psychosis (F11-F19 with fifth to sixth characters 51)
hallucinations in mood disorders with psychotic symptoms (F30.2, F31.5, F32.3, F33.3)
hallucinations in schizophrenia, schizotypal and delusional disorders (F20-F29)
Excludes2 disturbances of skin sensation (R20.-)
R44.0 Auditory hallucinations
R44.1 Visual hallucinations
R44.2 Other hallucinations
R44.3 Hallucinations, unspecified
R44.8 Other symptoms and signs involving general sensations and perceptions
R44.9 Unspecified symptoms and signs involving general sensations and perceptions
R45 Symptoms and signs involving emotional state
R45.0 Nervousness
Nervous tension
R45.1 Restlessness and agitation
R45.2 Unhappiness
R45.3 Demoralization and apathy
Excludes1 anhedonia (R45.84)
R45.4 Irritability and anger
R45.5 Hostility
R45.6 Violent behavior
R45.7 State of emotional shock and stress, unspecified
R45.8 Other symptoms and signs involving emotional state
R45.81 Low self-esteem
R45.82 Worries
R45.83 Excessive crying of child, adolescent or adult
Excludes1 excessive crying of infant (baby) R68.11
R45.84 Anhedonia
R45.85 Homicidal and suicidal ideations
Excludes1 suicide attempt (T14.91)
R45.850 Homicidal ideations
nonPrimary Yes
R45.851 Suicidal ideations
R45.86 Emotional lability
R45.87 Impulsiveness
R45.88 Nonsuicidal self-harm
Nonsuicidal self-injury
Nonsuicidal self-mutilation
Self-inflicted injury without suicidal intent
CodeAlso injury, if known
R45.89 Other symptoms and signs involving emotional state
Flat affect
Loneliness
R46 Symptoms and signs involving appearance and behavior
Excludes1 appearance and behavior in schizophrenia, schizotypal and delusional disorders (F20-F29)
mental and behavioral disorders (F01-F99)
R46.0 Very low level of personal hygiene
R46.1 Bizarre personal appearance
R46.2 Strange and inexplicable behavior
R46.3 Overactivity
R46.4 Slowness and poor responsiveness
Excludes1 stupor (R40.1)
R46.5 Suspiciousness and marked evasiveness
R46.6 Undue concern and preoccupation with stressful events
R46.7 Verbosity and circumstantial detail obscuring reason for contact
R46.8 Other symptoms and signs involving appearance and behavior
R46.81 Obsessive-compulsive behavior
Excludes1 obsessive-compulsive disorder (F42.-)
nonPrimary Yes
R46.89 Other symptoms and signs involving appearance and behavior
nonPrimary Yes