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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.728

R29.728

NIHSS score 28

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

Code Description

ICD-10 R29.728 is a billable code used to indicate a diagnosis of nihss score 28.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 28 indicates a severe stroke with significant neurological impairment. This score is derived from a comprehensive assessment of various neurological functions, including consciousness, language, motor skills, sensory perception, and visual fields. A score of 28 suggests that the patient exhibits profound deficits, such as severe aphasia, hemiplegia, and possibly altered consciousness. Patients with such high NIHSS scores are at increased risk for complications, including aspiration pneumonia, deep vein thrombosis, and further neurological deterioration. The clinical context for this code typically involves acute ischemic stroke or hemorrhagic stroke, where timely intervention is critical. Understanding the NIHSS score is essential for healthcare providers to gauge the severity of the stroke and to guide treatment decisions, rehabilitation planning, and prognostic discussions.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Interpretation of NIHSS scores can vary among clinicians.
  • Documentation must clearly reflect the severity of symptoms.
  • Differentiating between stroke types may require additional coding.
  • Potential for co-morbid conditions complicating the clinical picture.

Audit Risk Factors

  • Inadequate documentation of neurological deficits.
  • Failure to link NIHSS scores to specific clinical findings.
  • Misinterpretation of the NIHSS scoring system.
  • Inconsistent coding practices across different providers.

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of neurological assessments, including NIHSS components and any interventions.

Common Clinical Scenarios

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

Billing Considerations

Ensure that all neurological deficits are documented to support the severity indicated by the NIHSS score.

Emergency Medicine

Documentation Requirements

Immediate and thorough documentation of the patient's neurological status upon arrival, including NIHSS scoring.

Common Clinical Scenarios

Acute stroke presentations requiring rapid assessment and intervention.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use R29.728 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the NIHSS score is documented accurately and reflects the patient's clinical status
  • Use additional codes to capture any co
  • morbid conditions or complications

Exclusion Criteria

Do NOT use R29.728 When
No specific exclusions found.

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used when a patient with a NIHSS score of 28 is evaluated in the emergency department.

Documentation Requirements

Document the complexity of the visit and the severity of the patient's condition.

Specialty Considerations

Emergency medicine providers should ensure that all neurological assessments are clearly documented.

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, improving the accuracy of clinical data and reimbursement processes. R29.728 provides a clear indication of severe neurological impairment, which is critical for treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stroke severity, improving the accuracy of clinical data and reimbursement processes. R29.728 provides a clear indication of severe neurological impairment, which is critical for treatment planning and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. R29.728 provides a clear indication of severe neurological impairment, which is critical for treatment planning and resource allocation.

Resources

Clinical References

  • •
    NIH Stroke Scale Training

Coding & Billing References

  • •
    NIH Stroke Scale Training

Frequently Asked Questions

What does a NIHSS score of 28 indicate?

A NIHSS score of 28 indicates severe neurological impairment, often associated with significant deficits in motor function, speech, and consciousness, requiring urgent medical intervention.