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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.723

R29.723

NIHSS score 23

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R29.723 is a billable code used to indicate a diagnosis of nihss score 23.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 23 indicates a severe stroke, reflecting significant neurological impairment. This score is derived from a comprehensive assessment of various neurological functions, including consciousness, language, motor skills, and sensory perception. A score of 23 suggests that the patient exhibits profound deficits, such as severe aphasia, hemiparesis, and possible loss of consciousness. Common causes of such a high NIHSS score include ischemic strokes, hemorrhagic strokes, or transient ischemic attacks (TIAs) that have resulted in significant neurological damage. The clinical context surrounding this score is critical for determining the appropriate treatment and management strategies, as patients with such high scores often require immediate intervention to minimize long-term disability. Accurate documentation of the NIHSS score and associated clinical findings is essential for coding and billing purposes, as it directly impacts the level of care provided and the reimbursement process.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation of stroke symptoms
  • Need for precise documentation of neurological deficits
  • Potential for overlapping symptoms with other neurological conditions
  • Importance of timely and accurate scoring for treatment decisions

Audit Risk Factors

  • Inadequate documentation of NIHSS assessment
  • Failure to specify the type of stroke (ischemic vs. hemorrhagic)
  • Misinterpretation of NIHSS score leading to incorrect coding
  • Lack of supporting clinical findings for the score

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of neurological assessments, including NIHSS scores, patient history, and treatment plans.

Common Clinical Scenarios

Patients presenting with acute stroke symptoms, requiring hospitalization for management and monitoring.

Billing Considerations

Ensure that all neurological deficits are documented clearly to support the NIHSS score and subsequent coding.

Emergency Medicine

Documentation Requirements

Immediate documentation of NIHSS scores upon patient presentation, including vital signs and initial assessments.

Common Clinical Scenarios

Patients arriving at the emergency department with acute stroke symptoms, requiring rapid assessment and intervention.

Billing Considerations

Timeliness of documentation is critical; ensure that all assessments are recorded promptly to support coding.

Coding Guidelines

Inclusion Criteria

Use R29.723 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the NIHSS score is documented accurately and correlates with the clinical findings
  • The score should be recorded in conjunction with the patient's diagnosis and treatment plan

Exclusion Criteria

Do NOT use R29.723 When
No specific exclusions found.

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used when a patient with a high NIHSS score presents to the emergency department.

Documentation Requirements

Documentation must reflect the severity of the condition and the complexity of medical decision-making.

Specialty Considerations

Emergency medicine providers must ensure timely and accurate documentation to support the level of service billed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of stroke severity and associated symptoms, improving the accuracy of patient records and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stroke severity and associated symptoms, improving the accuracy of patient records and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    NIH Stroke Scale Training

Coding & Billing References

  • •
    NIH Stroke Scale Training

Frequently Asked Questions

What does an NIHSS score of 23 indicate?

An NIHSS score of 23 indicates severe neurological impairment, suggesting significant deficits in multiple areas such as motor function, language, and consciousness.