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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.735

R29.735

NIHSS score 35

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

Code Description

ICD-10 R29.735 is a billable code used to indicate a diagnosis of nihss score 35.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 35 indicates a severe stroke, reflecting significant neurological impairment. This score is derived from a comprehensive assessment of various neurological functions, including consciousness, vision, motor skills, sensation, language, and neglect. A score of 35 suggests profound deficits, with the patient likely exhibiting symptoms such as severe aphasia, hemiplegia, and altered consciousness. The NIHSS is critical in determining the severity of a stroke, guiding treatment decisions, and predicting outcomes. It is essential for clinicians to accurately assess and document the patient's neurological status to ensure appropriate coding and treatment. The NIHSS score is widely used in both acute and post-acute care settings, and a score this high typically necessitates immediate intervention and intensive rehabilitation services.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires precise assessment of multiple neurological functions.
  • High variability in patient presentation and scoring.
  • Documentation must reflect the severity and specific deficits.
  • Potential for misinterpretation of the score in clinical documentation.

Audit Risk Factors

  • Inconsistent documentation of NIHSS assessments.
  • Failure to capture all relevant neurological deficits.
  • Misalignment between clinical findings and coded score.
  • Inadequate justification for the severity of the score.

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of neurological assessments, including NIHSS components and any changes in patient status.

Common Clinical Scenarios

Patients presenting with acute stroke symptoms, requiring comprehensive neurological evaluation.

Billing Considerations

Ensure that all components of the NIHSS are documented to support the score assigned.

Emergency Medicine

Documentation Requirements

Immediate and thorough documentation of NIHSS score upon patient presentation, including any interventions initiated.

Common Clinical Scenarios

Acute stroke presentations requiring rapid assessment and treatment.

Billing Considerations

Timeliness of documentation is critical; ensure that the NIHSS score reflects the patient's condition at the time of assessment.

Coding Guidelines

Inclusion Criteria

Use R29.735 When
  • Follow official ICD
  • CM coding guidelines, ensuring that the NIHSS score is documented accurately and reflects the clinical findings
  • The score should be supported by comprehensive clinical documentation that details the patient's neurological status

Exclusion Criteria

Do NOT use R29.735 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

Document the severity of the condition and the NIHSS score.

Specialty Considerations

Emergency medicine providers should ensure that the visit reflects the acute nature of the stroke.

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 related conditions, improving the granularity of data for research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stroke severity and related conditions, improving the granularity of data for research and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of stroke severity and related conditions, improving the granularity of data for research and treatment outcomes.

Resources

Clinical References

  • •
    NIH Stroke Scale Training

Coding & Billing References

  • •
    NIH Stroke Scale Training

Frequently Asked Questions

What does an NIHSS score of 35 indicate?

An NIHSS score of 35 indicates severe neurological impairment, often associated with significant deficits in motor function, language, and consciousness, requiring immediate medical intervention.