R40.233UpcomingCategory · further specificity required

Coma scale, best motor response, abnormal flexion

R40.2 · Inherited instructions

Code first

any associated:
fracture of skull (S02.-)
intracranial injury (S06.-)

R40 · Inherited instructions

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)

R40.23 · Inherited instructions

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

Excludes 2 · 5

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Excludes 2

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)

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

Excludes 2

symptoms and signs constituting part of a pattern of mental disorder (F01-F99)

More specific codes

R40.2330Coma scale, best motor response, abnormal flexion, unspecified time R40.2331Coma scale, best motor response, abnormal flexion, in the field [EMT or ambulance]R40.2332Coma scale, best motor response, abnormal flexion, at arrival to emergency department R40.2333Coma scale, best motor response, abnormal flexion, at hospital admission R40.2334Coma scale, best motor response, abnormal flexion, 24 hours or more after hospital admission

Claims & coverage

When ICD-10-CM is required

For US diagnosis claims covered by HIPAA, ICD-10-CM is required from October 1, 2015.

Use the service date for outpatient/professional claims and the discharge date for hospital inpatient claims. Earlier encounters use ICD-9-CM; each individual code must also be valid for the applicable date.

Official coding guidelines → · CMS ↗

First observed · 2015-10-01

Code history

Latest recorded change · FY2019

ChangedUnchanged

FY2019

Effective from 2018-10-01

Title changed
Code-level rules changed

Coma scale, best motor response, abnormal flexion

Previous title: Coma scale, best motor response, abnormal

Category — select a more specific code

CDC/NCHS · FY2019

All editions (19)

All editions	Effective from	Code history
FY2016	2015-10-01	First observed
FY2017	2016-10-01	Inherited rules changed
FY2018	2017-10-01	Code-level rules changed
FY2019	2018-10-01	Title changed · Code-level rules changed
FY2020	2019-10-01	No tabular change
FY2020 · April	2020-04-01	No tabular change
FY2021	2020-10-01	No tabular change
FY2021 · 01-01	2021-01-01	No tabular change
FY2022	2021-10-01	No tabular change
FY2022 · 04-01	2022-04-01	No tabular change
FY2023	2022-10-01	No tabular change
FY2023 · 04-01	2023-04-01	No tabular change
FY2024	2023-10-01	No tabular change
FY2024 · 04-01	2024-04-01	No tabular change
FY2025	2024-10-01	No tabular change
FY2025 · 04-01	2025-04-01	No tabular change
FY2026	2025-10-01	No tabular change
FY2026 · April	2026-04-01	No tabular change
FY2027	2026-10-01	No tabular change

Code-level instructions

Inclusion terms

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)

Inherited instructions

R40.2 · Coma

Code first

any associated:
fracture of skull (S02.-)
intracranial injury (S06.-)

Note

One code from each subcategory, R40.21-R40.23, is required to complete the coma scale

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Excludes 2

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)

Note

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.

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

Excludes 2

symptoms and signs constituting part of a pattern of mental disorder (F01-F99)

R40 · Somnolence, 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)

R40.23 · Coma scale, best motor response

Seventh character

The following appropriate 7th character is to be added to subcategory R40.23-:

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

More specific codes

R40.2330Coma scale, best motor response, abnormal flexion, unspecified timeBillable / specific R40.2331Coma scale, best motor response, abnormal flexion, in the field [EMT or ambulance]Billable / specific R40.2332Coma scale, best motor response, abnormal flexion, at arrival to emergency departmentBillable / specific R40.2333Coma scale, best motor response, abnormal flexion, at hospital admissionBillable / specific R40.2334Coma scale, best motor response, abnormal flexion, 24 hours or more after hospital admissionBillable / specific

Official index references (4)

Coma (4)

Related codes

Other entries in the same category; these are not automatic substitutes.

Code	Description	Category · further specificity required
R40.231	Coma scale, best motor response, none	Category · further specificity required
R40.232	Coma scale, best motor response, extension	Category · further specificity required
R40.234	Coma scale, best motor response, flexion withdrawal	Category · further specificity required
R40.235	Coma scale, best motor response, localizes pain	Category · further specificity required
R40.236	Coma scale, best motor response, obeys commands	Category · further specificity required

Official titles and instructions are preserved in their source language. Official sources ↗

Chapters 18 · Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)

Excludes 2

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)

Note

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.