Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46)
R40Somnolence, stupor and coma
Excludes 1: 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)
R40.0Somnolence
› Drowsiness
Excludes 1: coma (R40.2-)
R40.1Stupor
› Catatonic stupor
› Semicoma
Excludes 1: catatonic schizophrenia (F20.2)
› coma (R40.2-)
› depressive stupor (F31-F33)
› dissociative stupor (F44.2)
› manic stupor (F30.2)
R40.2Coma
Code First: any associated:
› fracture of skull (S02.-)
› intracranial injury (S06.-)
One code from each subcategory, R40.21-R40.23, is required to complete the coma scale
R40.20Unspecified coma
› Coma NOS
› Unconsciousness NOS
R40.21Coma scale, eyes open
The following appropriate 7th character is to be added to subcategory R40.21-:
7th Character: 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
R40.211Coma scale, eyes open, never
› Coma scale eye opening score of 1
R40.212Coma scale, eyes open, to pain
› Coma scale eye opening score of 2
R40.213Coma scale, eyes open, to sound
› Coma scale eye opening score of 3
R40.214Coma scale, eyes open, spontaneous
› Coma scale eye opening score of 4
R40.22Coma scale, best verbal response
The following appropriate 7th character is to be added to subcategory R40.22-:
7th Character: 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
R40.221Coma scale, best verbal response, none
› Coma scale verbal score of 1
R40.222Coma 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)
R40.223Coma 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)
R40.224Coma 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)
R40.225Coma 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)
R40.23Coma scale, best motor response
The following appropriate 7th character is to be added to subcategory R40.23-:
7th Character: 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
R40.231Coma scale, best motor response, none
› Coma scale motor score of 1
R40.232Coma 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)
R40.233Coma 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)
R40.234Coma scale, best motor response, flexion withdrawal
› Coma scale motor score of 4
› Withdraws from pain or noxious stimuli (2-5 years of age)
R40.235Coma 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)
R40.236Coma 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)
R40.24Glasgow coma scale, total score
Assign a code from subcategory R40.24, when only the total coma score is documented
R40.241Glasgow coma scale score 13-15
R40.242Glasgow coma scale score 9-12
R40.243Glasgow coma scale score 3-8
R40.244Other coma, without documented Glasgow coma scale score, or with partial score reported
R40.2ANontraumatic coma due to underlying condition
› Secondary coma
Code First: underlying condition
R40.3Persistent vegetative state
R40.4Transient alteration of awareness
R41Other symptoms and signs involving cognitive functions and awareness
Excludes 1: dissociative [conversion] disorders (F44.-)
› mild cognitive impairment of uncertain or unknown etiology (G31.84)
R41.0Disorientation, unspecified
› Confusion NOS
› Delirium NOS
R41.1Anterograde amnesia
R41.2Retrograde amnesia
R41.3Other amnesia
› Amnesia NOS
› Memory loss NOS
Excludes 1: 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)
R41.4Neurologic neglect syndrome
› Asomatognosia
› Hemi-akinesia
› Hemi-inattention
› Hemispatial neglect
› Left-sided neglect
› Sensory neglect
› Visuospatial neglect
Excludes 1: visuospatial deficit (R41.842)
R41.8Other symptoms and signs involving cognitive functions and awareness
R41.81Age-related cognitive decline
› Senility NOS
R41.82Altered mental status, unspecified
› Change in mental status NOS
Excludes 1: altered level of consciousness (R40.-)
› altered mental status due to known condition - code to condition
› delirium NOS (R41.0)
R41.83Borderline intellectual functioning
› IQ level 71 to 84
Excludes 1: intellectual disabilities (F70-F79)
R41.84Other specified cognitive deficit
Excludes 1: cognitive deficits as sequelae of cerebrovascular disease (I69.01-, I69.11-, I69.21-, I69.31-, I69.81-, I69.91-)
R41.840Attention and concentration deficit
Excludes 1: attention-deficit hyperactivity disorders (F90.-)
R41.841Cognitive communication deficit
R41.842Visuospatial deficit
R41.843Psychomotor deficit
R41.844Frontal lobe and executive function deficit
R41.89Other symptoms and signs involving cognitive functions and awareness
› Anosognosia
R41.9Unspecified symptoms and signs involving cognitive functions and awareness
› Unspecified neurocognitive disorder
R42Dizziness and giddiness
› Light-headedness
› Vertigo NOS
Excludes 1: vertiginous syndromes (H81.-)
› vertigo from infrasound (T75.23)
R43Disturbances of smell and taste
R43.0Anosmia
R43.1Parosmia
R43.2Parageusia
R43.8Other disturbances of smell and taste
› Mixed disturbance of smell and taste
R43.9Unspecified disturbances of smell and taste
R44Other symptoms and signs involving general sensations and perceptions
Excludes 1: 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)
Excludes 2: disturbances of skin sensation (R20.-)
R44.0Auditory hallucinations
R44.1Visual hallucinations
R44.2Other hallucinations
R44.3Hallucinations, unspecified
R44.8Other symptoms and signs involving general sensations and perceptions
R44.9Unspecified symptoms and signs involving general sensations and perceptions
R45Symptoms and signs involving emotional state
R45.0Nervousness
› Nervous tension
R45.1Restlessness and agitation
R45.2Unhappiness
R45.3Demoralization and apathy
Excludes 1: anhedonia (R45.84)
R45.4Irritability and anger
R45.5Hostility
R45.6Violent behavior
R45.7State of emotional shock and stress, unspecified
R45.8Other symptoms and signs involving emotional state
R45.81Low self-esteem
R45.82Worries
R45.83Excessive crying of child, adolescent or adult
Excludes 1: excessive crying of infant (baby) R68.11
R45.84Anhedonia
R45.85Homicidal and suicidal ideations
Excludes 1: suicide attempt (T14.91)
R45.850Homicidal ideations
R45.851Suicidal ideations
R45.86Emotional lability
R45.87Impulsiveness
R45.88Nonsuicidal self-harm
› Nonsuicidal self-injury
› Nonsuicidal self-mutilation
› Self-inflicted injury without suicidal intent
Code Also: injury, if known
R45.89Other symptoms and signs involving emotional state
› Flat affect
› Loneliness
R46Symptoms and signs involving appearance and behavior
Excludes 1: appearance and behavior in schizophrenia, schizotypal and delusional disorders (F20-F29)
› mental and behavioral disorders (F01-F99)
R46.0Very low level of personal hygiene
R46.1Bizarre personal appearance
R46.2Strange and inexplicable behavior
R46.3Overactivity
R46.4Slowness and poor responsiveness
Excludes 1: stupor (R40.1)
R46.5Suspiciousness and marked evasiveness
R46.6Undue concern and preoccupation with stressful events
R46.7Verbosity and circumstantial detail obscuring reason for contact
R46.8Other symptoms and signs involving appearance and behavior
R46.81Obsessive-compulsive behavior
Excludes 1: obsessive-compulsive disorder (F42.-)
R46.89Other symptoms and signs involving appearance and behavior