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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.729

R29.729

NIHSS score 29

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

Code Description

ICD-10 R29.729 is a billable code used to indicate a diagnosis of nihss score 29.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 29 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, sensory perception, and visual fields. A score of 29 suggests that the patient exhibits profound deficits, potentially including severe aphasia, hemiplegia, and altered consciousness. This level of impairment necessitates immediate medical intervention and often indicates a poor prognosis. The NIHSS is crucial for determining treatment options, assessing the severity of the stroke, and monitoring the patient's progress over time. Accurate scoring is essential for effective communication among healthcare providers and for guiding clinical decisions. In clinical practice, a score of 29 may prompt considerations for advanced imaging, thrombolytic therapy, or surgical interventions, depending on the patient's overall clinical picture and timing of presentation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires precise clinical assessment and scoring.
  • Involves multiple neurological domains.
  • High variability in patient presentation.
  • Potential for misinterpretation of scores.

Audit Risk Factors

  • Inadequate documentation of neurological assessments.
  • Failure to link NIHSS score to clinical findings.
  • Misclassification of stroke severity.
  • Inconsistent scoring among providers.

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed neurological examination notes, including NIHSS scoring and rationale for score.

Common Clinical Scenarios

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

Billing Considerations

Ensure comprehensive documentation of all neurological deficits and their impact on daily functioning.

Emergency Medicine

Documentation Requirements

Immediate assessment notes, including time of onset, NIHSS score, and interventions initiated.

Common Clinical Scenarios

Patients arriving with acute stroke symptoms, requiring rapid assessment and treatment.

Billing Considerations

Document time-sensitive interventions and the patient's response to treatment.

Coding Guidelines

Inclusion Criteria

Use R29.729 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 supported by a comprehensive neurological examination

Exclusion Criteria

Do NOT use R29.729 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 29 is evaluated in the emergency department.

Documentation Requirements

Document the severity of the condition, NIHSS score, and interventions performed.

Specialty Considerations

Emergency medicine providers should ensure timely documentation to support the high severity level.

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 enhancing the ability to track outcomes and resource utilization.

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 enhancing the ability to track outcomes and resource utilization.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of stroke severity, improving the accuracy of clinical data and enhancing the ability to track outcomes and resource utilization.

Resources

Clinical References

  • •
    NIH Stroke Scale Training

Coding & Billing References

  • •
    NIH Stroke Scale Training

Frequently Asked Questions

What does a NIHSS score of 29 indicate?

A NIHSS score of 29 indicates severe neurological impairment, often associated with significant deficits in motor function, language, and consciousness, requiring urgent medical intervention.