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v1.0.0
ICD-10 Guide
ICD-10 CodesR29.740

R29.740

NIHSS score 40

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

Code Description

ICD-10 R29.740 is a billable code used to indicate a diagnosis of nihss score 40.

Key Diagnostic Point:

The NIHSS (National Institutes of Health Stroke Scale) score of 40 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, sensory perception, language, and neglect. A score of 40 suggests that the patient exhibits profound deficits across multiple domains, often leading to a complete inability to perform basic tasks or respond to stimuli. Patients with such a high NIHSS score typically present with severe aphasia, hemiplegia, and potentially coma, indicating a critical need for immediate medical intervention. The clinical context surrounding a NIHSS score of 40 often involves acute ischemic stroke or hemorrhagic stroke, necessitating rapid diagnostic imaging and therapeutic measures to mitigate further neurological damage. Understanding the implications of this score is crucial for healthcare providers in determining prognosis and treatment pathways.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires precise documentation of neurological deficits.
  • Involves understanding of stroke severity and implications.
  • Potential for misclassification if not properly assessed.
  • Need for correlation with imaging studies and clinical findings.

Audit Risk Factors

  • Inadequate documentation of neurological assessments.
  • Failure to correlate NIHSS score with clinical findings.
  • Misinterpretation of the NIHSS scoring system.
  • Inconsistent coding practices across providers.

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed neurological examination notes, imaging results, and treatment plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure comprehensive documentation of all neurological deficits and treatment responses.

Emergency Medicine

Documentation Requirements

Immediate assessment notes, NIHSS scoring, and initial treatment protocols.

Common Clinical Scenarios

Acute stroke presentations requiring rapid intervention and stabilization.

Billing Considerations

Accurate and timely documentation is critical for coding and treatment decisions.

Coding Guidelines

Inclusion Criteria

Use R29.740 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the NIHSS score is documented accurately and correlates with clinical findings
  • The code should be used when the NIHSS score is specifically noted as 40

Exclusion Criteria

Do NOT use R29.740 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 and high NIHSS scores.

Documentation Requirements

Detailed documentation of the patient's condition, NIHSS score, and treatment provided.

Specialty Considerations

Emergency medicine providers must ensure accurate and timely documentation to support coding.

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, including the NIHSS scores, which aids in better tracking and management of stroke patients.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of stroke severity, including the NIHSS scores, which aids in better tracking and management of stroke patients.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of stroke severity, including the NIHSS scores, which aids in better tracking and management of stroke patients.

Resources

Clinical References

  • •
    NIH Stroke Scale Training

Coding & Billing References

  • •
    NIH Stroke Scale Training

Frequently Asked Questions

What does an NIHSS score of 40 indicate?

An NIHSS score of 40 indicates severe neurological impairment, often associated with significant brain injury due to stroke.

How is the NIHSS score determined?

The NIHSS score is determined through a standardized assessment of various neurological functions, including consciousness, motor skills, and language.