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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.718

R29.718

NIHSS score 18

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

Code Description

ICD-10 R29.718 is a billable code used to indicate a diagnosis of nihss score 18.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 18 indicates a severe stroke with significant neurological impairment. This score reflects a range of symptoms including but not limited to altered consciousness, severe motor deficits, and expressive aphasia. Patients scoring 18 typically exhibit profound weakness on one side of the body, difficulty in speech, and may have visual field deficits. The NIHSS is a critical tool used to assess the severity of stroke and guide treatment decisions. A score of 18 suggests that the patient is at high risk for complications and may require intensive monitoring and intervention. Accurate assessment and documentation of the patient's neurological status are essential for appropriate coding and treatment planning.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of neurological assessments
  • Failure to capture all relevant symptoms leading to score determination
  • Misinterpretation of NIHSS scoring criteria
  • Inconsistent coding practices across different providers

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Comprehensive documentation of neurological assessments, including NIHSS scoring and any changes in patient status.

Common Clinical Scenarios

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

Billing Considerations

Ensure that all neurological deficits are documented to support the NIHSS score and justify the level of care.

Emergency Medicine

Documentation Requirements

Detailed documentation of initial assessment, NIHSS score, and any interventions performed.

Common Clinical Scenarios

Patients arriving at the emergency department with acute stroke symptoms, requiring immediate evaluation and treatment.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use R29.718 When
  • Follow official coding guidelines for the use of R29
  • 718, ensuring that the NIHSS score is documented accurately and reflects the patient's clinical status
  • The score should be derived from a comprehensive assessment of neurological function

Exclusion Criteria

Do NOT use R29.718 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 18 is evaluated in the emergency department.

Documentation Requirements

Document the severity of symptoms and the NIHSS score to justify the level of service.

Specialty Considerations

Emergency medicine providers should ensure timely documentation of assessments.

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 ability to capture the complexity of patient presentations and treatment needs.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stroke severity, improving the ability to capture the complexity of patient presentations and treatment needs.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of stroke severity, improving the ability to capture the complexity of patient presentations and treatment needs.

Resources

Clinical References

  • •
    NIH Stroke Scale Training

Coding & Billing References

  • •
    NIH Stroke Scale Training

Frequently Asked Questions

What does an NIHSS score of 18 indicate?

An NIHSS score of 18 indicates severe neurological impairment, suggesting significant deficits in motor function, speech, and consciousness, requiring urgent medical intervention.