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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.74

R29.74

NIHSS score 40-42

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

Code Description

ICD-10 R29.74 is a billable code used to indicate a diagnosis of nihss score 40-42.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 40-42 indicates a severe level of neurological impairment due to a stroke. This score reflects significant deficits in consciousness, motor function, language, and sensory perception. Patients with such high scores typically exhibit profound weakness or paralysis on one side of the body, inability to speak or understand language, and may present with altered levels of consciousness. The NIHSS is a critical tool in assessing the severity of a stroke and guiding treatment decisions. A score in this range suggests a high likelihood of poor outcomes and necessitates immediate and aggressive medical intervention. Common causes of such severe strokes include large vessel occlusions, embolic strokes, or hemorrhagic strokes. The diagnostic approach involves a thorough clinical evaluation, imaging studies such as CT or MRI to confirm the type of stroke, and continuous monitoring of neurological status. Accurate coding of this condition is essential for appropriate treatment planning and resource allocation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires precise understanding of NIHSS scoring criteria
  • Differentiation between types of strokes (ischemic vs. hemorrhagic)
  • Need for comprehensive documentation of neurological deficits
  • Potential for overlapping symptoms with other neurological conditions

Audit Risk Factors

  • Inadequate documentation of neurological assessments
  • Failure to specify the type of stroke
  • Misinterpretation of NIHSS scores leading to incorrect coding
  • Lack of supporting clinical evidence for high NIHSS scores

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed neurological examination findings, NIHSS score documentation, and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure comprehensive documentation of all neurological deficits and response to treatment.

Emergency Medicine

Documentation Requirements

Immediate assessment of NIHSS score, imaging results, and initial treatment interventions.

Common Clinical Scenarios

Patients arriving at the emergency department with acute onset of stroke symptoms.

Billing Considerations

Timely documentation is critical for coding and treatment decisions.

Coding Guidelines

Inclusion Criteria

Use R29.74 When
  • Follow official ICD
  • CM coding guidelines, ensuring that the NIHSS score is documented accurately and correlates with clinical findings
  • Use additional codes to specify the type of stroke when applicable

Exclusion Criteria

Do NOT use R29.74 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 is evaluated in the emergency department.

Documentation Requirements

Document the severity of symptoms, NIHSS score, and treatment provided.

Specialty Considerations

Emergency medicine providers must ensure timely and accurate documentation to support the level of service.

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 associated conditions, improving the accuracy of clinical data and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stroke severity and associated conditions, improving the accuracy of clinical data and treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of stroke severity and associated conditions, improving the accuracy of clinical data and 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 40-42 indicate?

A NIHSS score of 40-42 indicates severe neurological impairment, often associated with significant brain injury and a high likelihood of poor outcomes.