2027 ICD-10-CM Diagnosis Code R40.2344Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission

ICD-10-CM Codes›R00–R99›R40-R46›R40

ICD-10-CM R40.2344
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

R40.2344 is a billable ICD-10-CM diagnosis code for coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission. The 7th character 4 means 24 hours or more after hospital admission. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 80 through 81, 791, 793. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 718 closely related codes. The code is not accepted as a principal diagnosis by the Medicare Code Editor. As a symptom code, it should not be used as a principal diagnosis once a related definitive diagnosis has been established. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Nervous system signs and symptoms.

R40.2344 no longer risk-adjusts for Medicare Advantage: it mapped to HCC 80 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 80, ESRD (V21) category 80, and ESRD (V24) category 80 for payment year 2027.

Code Identity

ICD-10-CM Code
R40.2344
Billable Status
Yes — Valid for Submission
Code Describes
Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
Short Description
Coma scale, best motor response, flexion withdrawal, 24+hrs
Parent Code
R40.234
Coma scale, best motor response, flexion withdrawal

Code Classification

ChapterR00–R99Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
SectionR40-R46Symptoms and signs involving cognition, perception, emotional state and behavior
CategoryR40Somnolence, stupor and coma
This CodeR40.2344Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission

Code EditsBilling

Medicare Code Editor checks that affect claim validity for R40.2344.

Unacceptable principal diagnosis
There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Medicare Risk Adjustment (HCC)Billing

R40.2344 no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.

CMS-HCC V28 (Medicare Advantage Payment Model)
Not mapped
Dropped in V28 see all codes that no longer risk-adjust
Prior Model (CMS-HCC V24)
HCC 80
V24 retired last contributed to a Medicare Advantage risk score in payment year 2025
Other CMS Models
PACE (CMS-HCC V22): HCC 80 · ESRD (V21): HCC 80 · ESRD (V24): HCC 80
ESRD V21 weights: 0.043 dialysis, 0.000–0.184 functioning graft · ESRD V24 weights: 0.076 dialysis, 0.063–0.679 functioning graft
Part D (RxHCC)
Not mapped
R40.2344 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to R40.2344: its own notes plus those printed at R40.23, R40.2, R40, block R40-R46, and Chapter 18. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From R40 Somnolence, stupor and coma applies to 101 codes
  • 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)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Block R40-R46 Symptoms and signs involving cognition, perception, emotional state and behavior applies to 157 codes
  • symptoms and signs constituting part of a pattern of mental disorder (F01-F99)
From Chapter 18 (R00-R99) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified applies to 774 codes
  • abnormal findings on antenatal screening of mother (O28.-)
  • certain conditions originating in the perinatal period (P04-P96)
  • signs and symptoms classified in the body system chapters
  • signs and symptoms of breast (N63, N64.5)

Code First

The underlying condition named in the note is sequenced before this code.

From R40.2 Coma applies to 97 codes
  • any associated:
  • fracture of skull (S02.-)
  • intracranial injury (S06.-)

Notes

General instructions on how these codes are used.

From R40.2 Coma applies to 97 codes
  • One code from each subcategory, R40.21-R40.23, is required to complete the coma scale
From Chapter 18 (R00-R99) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified applies to 774 codes
  • This chapter includes symptoms, signs, abnormal results of clinical or other investigative procedures, and ill-defined conditions regarding which no diagnosis classifiable elsewhere is recorded.
  • Signs and symptoms that point rather definitely to a given diagnosis have been assigned to a category in other chapters of the classification. In general, categories in this chapter include the less well-defined conditions and symptoms that, without the necessary study of the case to establish a final diagnosis, point perhaps equally to two or more diseases or to two or more systems of the body. Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'. The Alphabetical Index should be consulted to determine which symptoms and signs are to be allocated here and which to other chapters. The residual subcategories, numbered .8, are generally provided for other relevant symptoms that cannot be allocated elsewhere in the classification.
  • The conditions and signs or symptoms included in categories R00-R94 consist of:
  • (a) cases for which no more specific diagnosis can be made even after all the facts bearing on the case have been investigated;
  • (b) signs or symptoms existing at the time of initial encounter that proved to be transient and whose causes could not be determined;
  • (c) provisional diagnosis in a patient who failed to return for further investigation or care;
  • (d) cases referred elsewhere for investigation or treatment before the diagnosis was made;
  • (e) cases in which a more precise diagnosis was not available for any other reason;
  • (f) certain symptoms, for which supplementary information is provided, that represent important problems in medical care in their own right.

7th Character

Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.

From R40.23 Coma scale, best motor response applies to 30 codes
  • The following appropriate 7th character is to be added to subcategory R40.23-:
Values for category R40.23 Coma Scale Timing
  • 0unspecified time
  • 1in the field [EMT or ambulance]
  • 2at arrival to emergency department
  • 3at hospital admission
  • 424 hours or more after hospital admission this code

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name R40.2344, its category, or a range that includes it.

Excludes1 5

These codes carry an Excludes1 note naming R40.2344: they are not reported together with it, unless the two conditions are unrelated.

  • R40.0 Somnolence
    coma (R40.2-) names R40.2-, which includes this code
  • R40.1 Stupor
    coma (R40.2-) names R40.2-, which includes this code
  • R40.2A Nontraumatic coma due to underlying condition
    Glasgow coma scale, total score (R40.23.-) names R40.23.-, which includes this code
  • R41.82 Altered mental status, unspecified
    altered level of consciousness (R40.-) names R40.-, which includes this code
  • R55 Syncope and collapse
    unconsciousness NOS (R40.2-) names R40.2-, which includes this code

Use Additional Code 2

These codes say to use an additional code from the note, and R40.2344 is one of the codes named.

  • T65.85 Toxic effect of medetomidine
    somnolence, stupor and coma (R40.-) names R40.-, which includes this code
  • T67.0 Heatstroke and sunstroke
    coma and stupor (R40.-) names R40.-, which includes this code

Notes 1

These notes mention R40.2344.

  • R40.2 Coma
    One code from each subcategory, R40.21-R40.23, is required to complete the coma scale names R40.21-R40.23, which includes this code

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR SYM010
Nervous system signs and symptoms
Default principal diagnosis: inpatient No · outpatient No

Clinical InformationClinical

  • 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.

Convert R40.2344 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
780.01 Coma
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About R40.2344Overview

Is R40.2344 (Coma scale, best motor response, flexion withdrawal) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character 4 in R40.2344 mean?

The final character 4 means 24 hours or more after hospital admission, in this case for the coma scale, best motor response, flexion withdrawal. It comes from the 7th character list in the CMS Tabular List for this category.

What MS-DRG does R40.2344 group to?

On inpatient claims, coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission maps to MS-DRG 793, 791, 81, 80, with relative weights from 0.7941 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.

Is R40.2344 a CC or MCC?

CMS lists R40.2344 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 718 closely related codes in its exclusion list.

Can R40.2344 be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.

Does R40.2344 risk-adjust for Medicare Advantage payment?

Not for Medicare Advantage. R40.2344 mapped to HCC 80 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 80 (Coma/Brain Compression/Anoxic Damage), ESRD (V21) category 80 (Coma/Brain Compression/Anoxic Damage), and ESRD (V24) category 80 (Coma/Brain Compression/Anoxic Damage).