Somnolence, stupor and coma (R40)

Browse all the diagnosis codes used for somnolence, stupor and coma (r40). For easy navigation, the diagnosis codes are sorted in alphabetical order and grouped by sections. Each section is clearly marked with its description, and the corresponding three-digit code range. This format makes it simple to browse diagnosis codes in this chapter or section and find what you're looking for. We've also added green checkmark icons to label billable codes, and red warning icons for non-billable ones. This makes it easy to identify which codes can be billed.

Clinical Information

Akinetic Mutism - A syndrome characterized by a silent and inert state without voluntary motor activity despite preserved sensorimotor pathways and vigilance. Bilateral FRONTAL LOBE dysfunction involving the anterior cingulate gyrus and related brain injuries are associated with this condition. This may result in impaired abilities to communicate and initiate motor activities. (From Adams et al., Principles of Neurology, 6th ed, p348; Fortschr Neurol Psychiatr 1995 Feb;63(2):59-67)

Brain Death - A state of prolonged irreversible cessation of all brain activity, including lower brain stem function with the complete absence of voluntary movements, responses to stimuli, brain stem reflexes, and spontaneous respirations. Reversible conditions which mimic this clinical state (e.g., sedative overdose, hypothermia, etc.) are excluded prior to making the determination of brain death. (From Adams et al., Principles of Neurology, 6th ed, pp348-9)

Coma - A profound state of unconsciousness associated with depressed cerebral activity from which the individual cannot be aroused. Coma generally occurs when there is dysfunction or injury involving both cerebral hemispheres or the brain stem RETICULAR FORMATION.

Coma, Post-Head Injury - Prolonged unconsciousness from which the individual cannot be aroused, associated with traumatic injuries to the BRAIN. This may be defined as unconsciousness persisting for 6 hours or longer. Coma results from injury to both cerebral hemispheres or the RETICULAR FORMATION of the BRAIN STEM. Contributing mechanisms include DIFFUSE AXONAL INJURY and BRAIN EDEMA. (From J Neurotrauma 1997 Oct;14(10):699-713)

Comamonadaceae - A family of gram-negative aerobic bacteria in the order BURKHOLDERIALES, encompassing the acidovorans rRNA complex. Some species are pathogenic to PLANTS.

Comamonas - A genus of gram-negative, straight or slightly curved rods which are motile by polar flagella and which accumulate poly-beta-hydroxybutyrate within the cells.

Comamonas testosteroni - A species of gram-negative, aerobic rods formerly called Pseudomonas testosteroni. It is differentiated from other Comamonas species by its ability to assimilate testosterone and to utilize phenylacetate or maleate as carbon sources.

Convulsive Therapy - Convulsions induced in order to treat MENTAL DISORDERS. It is used primarily in the treatment of severe affective disorders and SCHIZOPHRENIA.

Delftia - A genus of gram-negative, strictly aerobic chemoorganotrophic bacteria, in the family COMAMONADACEAE.

Delftia acidovorans - A species of gram-negative rod-shaped bacteria found ubiquitously and formerly called Comamonas acidovorans and Pseudomonas acidovorans. It is the type species of the genus DELFTIA.

Diabetic Coma - A state of unconsciousness as a complication of diabetes mellitus. It occurs in cases of extreme HYPERGLYCEMIA or extreme HYPOGLYCEMIA as a complication of INSULIN therapy.

Frontal Lobe - The part of the cerebral hemisphere anterior to the central sulcus, and anterior and superior to the lateral sulcus.

Glasgow Coma Scale - A scale that assesses the response to stimuli in patients with craniocerebral injuries. The parameters are eye opening, motor response, and verbal response.

Hepatic Encephalopathy - A syndrome characterized by central nervous system dysfunction in association with LIVER FAILURE, including portal-systemic shunts. Clinical features include lethargy and CONFUSION (frequently progressing to COMA); ASTERIXIS; NYSTAGMUS, PATHOLOGIC; brisk oculovestibular reflexes; decorticate and decerebrate posturing; MUSCLE SPASTICITY; and bilateral extensor plantar reflexes (see REFLEX, BABINSKI). ELECTROENCEPHALOGRAPHY may demonstrate triphasic waves. (From Adams et al., Principles of Neurology, 6th ed, pp1117-20; Plum & Posner, Diagnosis of Stupor and Coma, 3rd ed, p222-5)

Hyperglycemic Hyperosmolar Nonketotic Coma - A serious complication of TYPE 2 DIABETES MELLITUS. It is characterized by extreme HYPERGLYCEMIA; DEHYDRATION; serum hyperosmolarity; and depressed consciousness leading to COMA in the absence of KETOSIS and ACIDOSIS.

Insulin Coma - Severe HYPOGLYCEMIA induced by a large dose of exogenous INSULIN resulting in a COMA or profound state of unconsciousness from which the individual cannot be aroused.

Persistent Vegetative State - Vegetative state refers to the neurocognitive status of individuals with severe brain damage, in whom physiologic functions (sleep-wake cycles, autonomic control, and breathing) persist, but awareness (including all cognitive function and emotion) is abolished.

Reticular Formation - A region extending from the PONS & MEDULLA OBLONGATA through the MESENCEPHALON, characterized by a diversity of neurons of various sizes and shapes, arranged in different aggregations and enmeshed in a complicated fiber network.

Santalaceae - A plant family of the order Santalales, subclass Rosidae, class Magnoliopsida. They are parasites that form connections (haustoria) to their hosts to obtain water and nutrients. The one-seeded fruit may be surrounded by a brightly colored nut-like structure.

Stupor - A state of reduced sensibility and response to stimuli which is distinguished from COMA in that the person can be aroused by vigorous and repeated stimulation. The person is still conscious and can make voluntary movements. It can be induced by CENTRAL NERVOUS SYSTEM AGENTS. The word derives from Latin stupere and is related to stunned, stupid, dazed or LETHARGY.

Instructional Notations

Type 1 Excludes

A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

  • 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
  • Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00–R99)

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

        • Somnolence, stupor and coma (R40)

        • R40 Somnolence, stupor and coma
        • R40.0 Somnolence
        • R40.1 Stupor
        • R40.2 Coma
        • R40.20 Unspecified coma
        • R40.21 Coma scale, eyes open
        • R40.211 Coma scale, eyes open, never
        • R40.2110 Coma scale, eyes open, never, unspecified time
        • R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance]
        • R40.2112 Coma scale, eyes open, never, at arrival to emergency department
        • R40.2113 Coma scale, eyes open, never, at hospital admission
        • R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission
        • R40.212 Coma scale, eyes open, to pain
        • R40.2120 Coma scale, eyes open, to pain, unspecified time
        • R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance]
        • R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department
        • R40.2123 Coma scale, eyes open, to pain, at hospital admission
        • R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission
        • R40.213 Coma scale, eyes open, to sound
        • R40.2130 Coma scale, eyes open, to sound, unspecified time
        • R40.2131 Coma scale, eyes open, to sound, in the field [EMT or ambulance]
        • R40.2132 Coma scale, eyes open, to sound, at arrival to emergency department
        • R40.2133 Coma scale, eyes open, to sound, at hospital admission
        • R40.2134 Coma scale, eyes open, to sound, 24 hours or more after hospital admission
        • R40.214 Coma scale, eyes open, spontaneous
        • R40.2140 Coma scale, eyes open, spontaneous, unspecified time
        • R40.2141 Coma scale, eyes open, spontaneous, in the field [EMT or ambulance]
        • R40.2142 Coma scale, eyes open, spontaneous, at arrival to emergency department
        • R40.2143 Coma scale, eyes open, spontaneous, at hospital admission
        • R40.2144 Coma scale, eyes open, spontaneous, 24 hours or more after hospital admission
        • R40.22 Coma scale, best verbal response
        • R40.221 Coma scale, best verbal response, none
        • R40.2210 Coma scale, best verbal response, none, unspecified time
        • R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance]
        • R40.2212 Coma scale, best verbal response, none, at arrival to emergency department
        • R40.2213 Coma scale, best verbal response, none, at hospital admission
        • R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission
        • R40.222 Coma scale, best verbal response, incomprehensible words
        • R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time
        • R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
        • R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
        • R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
        • R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
        • R40.223 Coma scale, best verbal response, inappropriate words
        • R40.2230 Coma scale, best verbal response, inappropriate words, unspecified time
        • R40.2231 Coma scale, best verbal response, inappropriate words, in the field [EMT or ambulance]
        • R40.2232 Coma scale, best verbal response, inappropriate words, at arrival to emergency department
        • R40.2233 Coma scale, best verbal response, inappropriate words, at hospital admission
        • R40.2234 Coma scale, best verbal response, inappropriate words, 24 hours or more after hospital admission
        • R40.224 Coma scale, best verbal response, confused conversation
        • R40.2240 Coma scale, best verbal response, confused conversation, unspecified time
        • R40.2241 Coma scale, best verbal response, confused conversation, in the field [EMT or ambulance]
        • R40.2242 Coma scale, best verbal response, confused conversation, at arrival to emergency department
        • R40.2243 Coma scale, best verbal response, confused conversation, at hospital admission
        • R40.2244 Coma scale, best verbal response, confused conversation, 24 hours or more after hospital admission
        • R40.225 Coma scale, best verbal response, oriented
        • R40.2250 Coma scale, best verbal response, oriented, unspecified time
        • R40.2251 Coma scale, best verbal response, oriented, in the field [EMT or ambulance]
        • R40.2252 Coma scale, best verbal response, oriented, at arrival to emergency department
        • R40.2253 Coma scale, best verbal response, oriented, at hospital admission
        • R40.2254 Coma scale, best verbal response, oriented, 24 hours or more after hospital admission
        • R40.23 Coma scale, best motor response
        • R40.231 Coma scale, best motor response, none
        • R40.2310 Coma scale, best motor response, none, unspecified time
        • R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance]
        • R40.2312 Coma scale, best motor response, none, at arrival to emergency department
        • R40.2313 Coma scale, best motor response, none, at hospital admission
        • R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission
        • R40.232 Coma scale, best motor response, extension
        • R40.2320 Coma scale, best motor response, extension, unspecified time
        • R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance]
        • R40.2322 Coma scale, best motor response, extension, at arrival to emergency department
        • R40.2323 Coma scale, best motor response, extension, at hospital admission
        • R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission
        • R40.233 Coma scale, best motor response, abnormal flexion
        • R40.2330 Coma scale, best motor response, abnormal flexion, unspecified time
        • R40.2331 Coma scale, best motor response, abnormal flexion, in the field [EMT or ambulance]
        • R40.2332 Coma scale, best motor response, abnormal flexion, at arrival to emergency department
        • R40.2333 Coma scale, best motor response, abnormal flexion, at hospital admission
        • R40.2334 Coma scale, best motor response, abnormal flexion, 24 hours or more after hospital admission
        • R40.234 Coma scale, best motor response, flexion withdrawal
        • R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time
        • R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
        • R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
        • R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission
        • R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
        • R40.235 Coma scale, best motor response, localizes pain
        • R40.2350 Coma scale, best motor response, localizes pain, unspecified time
        • R40.2351 Coma scale, best motor response, localizes pain, in the field [EMT or ambulance]
        • R40.2352 Coma scale, best motor response, localizes pain, at arrival to emergency department
        • R40.2353 Coma scale, best motor response, localizes pain, at hospital admission
        • R40.2354 Coma scale, best motor response, localizes pain, 24 hours or more after hospital admission
        • R40.236 Coma scale, best motor response, obeys commands
        • R40.2360 Coma scale, best motor response, obeys commands, unspecified time
        • R40.2361 Coma scale, best motor response, obeys commands, in the field [EMT or ambulance]
        • R40.2362 Coma scale, best motor response, obeys commands, at arrival to emergency department
        • R40.2363 Coma scale, best motor response, obeys commands, at hospital admission
        • R40.2364 Coma scale, best motor response, obeys commands, 24 hours or more after hospital admission
        • R40.24 Glasgow coma scale, total score
        • R40.241 Glasgow coma scale score 13-15
        • R40.2410 Glasgow coma scale score 13-15, unspecified time
        • R40.2411 Glasgow coma scale score 13-15, in the field [EMT or ambulance]
        • R40.2412 Glasgow coma scale score 13-15, at arrival to emergency department
        • R40.2413 Glasgow coma scale score 13-15, at hospital admission
        • R40.2414 Glasgow coma scale score 13-15, 24 hours or more after hospital admission
        • R40.242 Glasgow coma scale score 9-12
        • R40.2420 Glasgow coma scale score 9-12, unspecified time
        • R40.2421 Glasgow coma scale score 9-12, in the field [EMT or ambulance]
        • R40.2422 Glasgow coma scale score 9-12, at arrival to emergency department
        • R40.2423 Glasgow coma scale score 9-12, at hospital admission
        • R40.2424 Glasgow coma scale score 9-12, 24 hours or more after hospital admission
        • R40.243 Glasgow coma scale score 3-8
        • R40.2430 Glasgow coma scale score 3-8, unspecified time
        • R40.2431 Glasgow coma scale score 3-8, in the field [EMT or ambulance]
        • R40.2432 Glasgow coma scale score 3-8, at arrival to emergency department
        • R40.2433 Glasgow coma scale score 3-8, at hospital admission
        • R40.2434 Glasgow coma scale score 3-8, 24 hours or more after hospital admission
        • R40.244 Other coma, without documented Glasgow coma scale score, or with partial score reported
        • R40.2440 Other coma, without documented Glasgow coma scale score, or with partial score reported, unspecified time
        • R40.2441 Other coma, without documented Glasgow coma scale score, or with partial score reported, in the field [EMT or ambulance]
        • R40.2442 Other coma, without documented Glasgow coma scale score, or with partial score reported, at arrival to emergency department
        • R40.2443 Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission
        • R40.2444 Other coma, without documented Glasgow coma scale score, or with partial score reported, 24 hours or more after hospital admission
        • R40.2A Nontraumatic coma due to underlying condition NEW CODE
        • R40.3 Persistent vegetative state
        • R40.4 Transient alteration of awareness