2027 ICD-10-CM Diagnosis Code R40.2443Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission

ICD-10-CM Codes›R00–R99›R40-R46›R40

ICD-10-CM R40.2443
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

R40.2443 is a billable ICD-10-CM diagnosis code for other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission. The 7th character 3 means at hospital admission. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. 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.

For Medicare Advantage risk adjustment, R40.2443 maps to CMS-HCC Category 202 (Coma, Brain Compression/Anoxic Damage) under the V28 model, adding a risk factor of about 0.543 for a community, non-dual, aged beneficiary in payment year 2027.

Code Identity

ICD-10-CM Code
R40.2443
Billable Status
Yes — Valid for Submission
Code Describes
Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission
Short Description
Other coma, without Glasgow, or w/part score, admit
Parent Code
R40.244
Other coma, without documented Glasgow coma scale score, or with partial score reported

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 CodeR40.2443Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission

Code EditsBilling

Medicare Code Editor checks that affect claim validity for R40.2443.

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

R40.2443 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.

CMS-HCC V28 Category (Payment Model)
HCC 202— Coma, Brain Compression/Anoxic Damage
Payment HCC · PY 2027 one of 61 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.543
community, non-dual, aged · ranges 0.097–0.721 across segments
Hierarchy
Superseded by HCC 63, HCC 397, and HCC 398
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 80
V24 retired V28 pays 100% of MA risk scores since PY 2026
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
R40.2443 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 R40.2443: its own notes plus those printed at R40.24, 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 R40.24 Glasgow coma scale, total score applies to 20 codes
  • Assign a code from subcategory R40.24, when only the total coma score is documented
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 R40.24 Glasgow coma scale, total score applies to 20 codes
  • The following appropriate 7th character is to be added to subcategory R40.24-:
Values for category R40.24 Coma Scale Timing
  • 0unspecified time
  • 1in the field [EMT or ambulance]
  • 2at arrival to emergency department
  • 3at hospital admission this code
  • 424 hours or more after hospital admission

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

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name R40.2443, its category, or a range that includes it.

Excludes1 5

These codes carry an Excludes1 note naming R40.2443: 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
    coma scale, best motor response (R40.24.-) names R40.24.-, 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 R40.2443 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 R40.2443.

  • R40.24 Glasgow coma scale, total score
    Assign a code from subcategory R40.24, when only the total coma score is documented names R40.24, 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 R40.2443 to ICD-9-CMHistory

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

ICD-9-CM
No Map There is no ICD-9 equivalent for this code.

Code History & ChangesHistory

Replacement R40.2443 replaces the following previously assigned code(s):

  • R40.244 - Oth coma,w/o Glasgow coma scale score,or w/part score report
FY 2019AddedAdded to the ICD-10-CM code setEffective October 1, 2018.
FY 2020–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About R40.2443Overview

Is R40.2443 a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character 3 in R40.2443 mean?

The final character 3 means at hospital admission, in this case for the other coma, without documented Glasgow coma scale score, or with partial score reported. It comes from the 7th character list in the CMS Tabular List for this category.

What MS-DRG does R40.2443 group to?

On inpatient claims, other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission maps to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.

Can R40.2443 be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.

Can R40.2443 be reported with P91.5?

Not as a rule. The Excludes1 note at R40, which applies to R40.2443, lists "neonatal coma (P91.5)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What HCC is R40.2443?

R40.2443 (other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission) maps to CMS-HCC Category 202 (Coma, Brain Compression/Anoxic Damage), commonly written as HCC 202, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 80 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.

Does R40.2443 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, R40.2443 adds a risk adjustment factor of about 0.543 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.097 to 0.721 depending on the payment segment). A more severe related category (HCC 63, HCC 397, and HCC 398) supersedes it when both are reported. See the full factor table on the HCC 202 category page.