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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.731

R29.731

NIHSS score 31

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

Code Description

ICD-10 R29.731 is a billable code used to indicate a diagnosis of nihss score 31.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 31 indicates a severe stroke, reflecting significant neurological impairment. This score is derived from a comprehensive assessment of various neurological functions, including consciousness, vision, motor function, sensation, language, and neglect. A score of 31 suggests profound deficits, often leading to a high risk of long-term disability or death. Patients may exhibit symptoms such as complete hemiplegia, inability to speak, severe visual field deficits, and altered consciousness. The NIHSS is crucial for determining the severity of a stroke and guiding treatment decisions, including eligibility for thrombolytic therapy. Accurate scoring and documentation are essential for effective patient management and coding purposes, as they directly influence treatment protocols and reimbursement processes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation of stroke symptoms
  • Need for precise scoring and documentation
  • Differentiation between stroke types (ischemic vs. hemorrhagic)
  • Potential for comorbid conditions affecting scoring

Audit Risk Factors

  • Inadequate documentation of NIHSS scoring
  • Failure to specify the type of stroke
  • Misinterpretation of neurological deficits
  • Inconsistent scoring across different assessments

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of neurological assessments, including NIHSS scoring and any comorbidities.

Common Clinical Scenarios

Management of stroke patients in inpatient settings, including monitoring and rehabilitation.

Billing Considerations

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

Emergency Medicine

Documentation Requirements

Immediate documentation of NIHSS score upon patient presentation, including acute symptoms and interventions.

Common Clinical Scenarios

Acute stroke presentations requiring rapid assessment and treatment decisions.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use R29.731 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the NIHSS score is accurately documented and correlates with clinical findings
  • Use additional codes to specify the type of stroke and any associated conditions

Exclusion Criteria

Do NOT use R29.731 When
No specific exclusions found.

Related CPT Codes

99285CPT Code

Emergency department visit, high severity

Clinical Scenario

Used for patients presenting with severe stroke symptoms requiring immediate intervention.

Documentation Requirements

Document the severity of symptoms and NIHSS score.

Specialty Considerations

Emergency medicine providers should ensure timely and accurate documentation.

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. R29.731 provides a clear indication of severe neurological impairment, which is critical for treatment planning.

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. R29.731 provides a clear indication of severe neurological impairment, which is critical for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. R29.731 provides a clear indication of severe neurological impairment, which is critical for treatment planning.

Resources

Clinical References

  • •
    NIH Stroke Scale Training

Coding & Billing References

  • •
    NIH Stroke Scale Training

Frequently Asked Questions

What does a NIHSS score of 31 indicate?

A NIHSS score of 31 indicates severe neurological impairment, often associated with a high risk of disability or death following a stroke.