ICD-10-CM Code R40.2

Coma

Version 2020 Non-Billable Code No Valid Principal Dx

Not Valid for Submission

R40.2 is a "header" nonspecific and non-billable code code, consider using a code with a higher level of specificity for a diagnosis of coma. The code is NOT valid for the year 2020 for the submission of HIPAA-covered transactions.

ICD-10:R40.2
Short Description:Coma
Long Description:Coma

Consider the following ICD-10 codes with a higher level of specificity:

  • 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

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code R40.2:

Code First

Code First
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
  • any associated:
  • fracture of skull S02
  • intracranial injury S06


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;632:59 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.
  • CONVULSIVE THERAPY-. convulsions induced in order to treat mental disorders. it is used primarily in the treatment of severe affective disorders and schizophrenia.
  • 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.
  • 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.
  • 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.
  • 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;1410:699 713
  • 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.
  • 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.
  • 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.
  • COMAMONADACEAE-. a family of gram negative aerobic bacteria in the order burkholderiales encompassing the acidovorans rrna complex. some species are pathogenic to plants.

Code Classification

  • 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)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Coma

A coma is a deep state of unconsciousness. An individual in a coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as brain injury.

A coma rarely lasts more than 2 to 4 weeks. The outcome for coma depends on the cause, severity, and site of the damage. People may come out of a coma with physical, intellectual, and psychological problems. Some people may remain in a coma for years or even decades. For those people, the most common cause of death is infection, such as pneumonia.

NIH: National Institute of Neurological Disorders and Stroke


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