R40Not billable, use a more specific code below
Somnolence, stupor and coma
In Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46), chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings
101 billable codes under R40: 37 are an MCC, 1 is a CC; 43 map to HCC 202 (Coma, Brain Compression/Anoxic Damage).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.
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Instructional notes
Also applies, from Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46)
These notes sit on R40-R46 and apply to every code under it, including R40.
Excludes2: not included here, code separately if applicable
- symptoms and signs constituting part of a pattern of mental disorder (F01-F99)
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Covers when to report symptom, sign, and abnormal finding codes (R00-R99), plus specific rules for falls, coma scales, non-infectious SIRS, death NOS, and NIHSS scores.
- Use of symptom codes (page 75)
- Use of a symptom code with a definitive diagnosis code (page 75)
- Combination codes that include symptoms (page 75)
- Repeated falls (page 76)
- Coma (page 76)
- Functional quadriplegia (page 76)
- SIRS due to Non-Infectious Process (page 77)
- Death NOS (page 77)
All codes under R40
R40 can't be used on a claim. Pick a billable code below; grey headings group them.
- R40.0Somnolence
- R40.1Stupor
- R40.2Coma
- R40.20Unspecified coma
- R40.21Coma scale, eyes open
- R40.211Coma scale, eyes open, never
- R40.2110Coma scale, eyes open, never, unspecified time
- R40.2111Coma scale, eyes open, never, in the field [EMT or ambulance]
- R40.2112Coma scale, eyes open, never, at arrival to emergency department
- R40.2113Coma scale, eyes open, never, at hospital admission
- R40.2114Coma scale, eyes open, never, 24 hours or more after hospital admission
- R40.212Coma scale, eyes open, to pain
- R40.2120Coma scale, eyes open, to pain, unspecified time
- R40.2121Coma scale, eyes open, to pain, in the field [EMT or ambulance]
- R40.2122Coma scale, eyes open, to pain, at arrival to emergency department
- R40.2123Coma scale, eyes open, to pain, at hospital admission
- R40.2124Coma scale, eyes open, to pain, 24 hours or more after hospital admission
- R40.213Coma scale, eyes open, to sound
- R40.2130Coma scale, eyes open, to sound, unspecified time
- R40.2131Coma scale, eyes open, to sound, in the field [EMT or ambulance]
- R40.2132Coma scale, eyes open, to sound, at arrival to emergency department
- R40.2133Coma scale, eyes open, to sound, at hospital admission
- R40.2134Coma scale, eyes open, to sound, 24 hours or more after hospital admission
- R40.214Coma scale, eyes open, spontaneous
- R40.2140Coma scale, eyes open, spontaneous, unspecified time
- R40.2141Coma scale, eyes open, spontaneous, in the field [EMT or ambulance]
- R40.2142Coma scale, eyes open, spontaneous, at arrival to emergency department
- R40.2143Coma scale, eyes open, spontaneous, at hospital admission
- R40.2144Coma scale, eyes open, spontaneous, 24 hours or more after hospital admission
- R40.22Coma scale, best verbal response
- R40.221Coma scale, best verbal response, none
- R40.2210Coma scale, best verbal response, none, unspecified time
- R40.2211Coma scale, best verbal response, none, in the field [EMT or ambulance]
- R40.2212Coma scale, best verbal response, none, at arrival to emergency department
- R40.2213Coma scale, best verbal response, none, at hospital admission
- R40.2214Coma scale, best verbal response, none, 24 hours or more after hospital admission
- R40.222Coma scale, best verbal response, incomprehensible words
- R40.2220Coma scale, best verbal response, incomprehensible words, unspecified time
- R40.2221Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
- R40.2222Coma scale, best verbal response, incomprehensible words, at arrival to emergency department
- R40.2223Coma scale, best verbal response, incomprehensible words, at hospital admission
- R40.2224Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
- R40.223Coma scale, best verbal response, inappropriate words
- R40.2230Coma scale, best verbal response, inappropriate words, unspecified time
- R40.2231Coma scale, best verbal response, inappropriate words, in the field [EMT or ambulance]
- R40.2232Coma scale, best verbal response, inappropriate words, at arrival to emergency department
- R40.2233Coma scale, best verbal response, inappropriate words, at hospital admission
- R40.2234Coma scale, best verbal response, inappropriate words, 24 hours or more after hospital admission
- R40.224Coma scale, best verbal response, confused conversation
- R40.2240Coma scale, best verbal response, confused conversation, unspecified time
- R40.2241Coma scale, best verbal response, confused conversation, in the field [EMT or ambulance]
- R40.2242Coma scale, best verbal response, confused conversation, at arrival to emergency department
- R40.2243Coma scale, best verbal response, confused conversation, at hospital admission
- R40.2244Coma scale, best verbal response, confused conversation, 24 hours or more after hospital admission
- R40.225Coma scale, best verbal response, oriented
- R40.2250Coma scale, best verbal response, oriented, unspecified time
- R40.2251Coma scale, best verbal response, oriented, in the field [EMT or ambulance]
- R40.2252Coma scale, best verbal response, oriented, at arrival to emergency department
- R40.2253Coma scale, best verbal response, oriented, at hospital admission
- R40.2254Coma scale, best verbal response, oriented, 24 hours or more after hospital admission
- R40.23Coma scale, best motor response
- R40.231Coma scale, best motor response, none
- R40.2310Coma scale, best motor response, none, unspecified time
- R40.2311Coma scale, best motor response, none, in the field [EMT or ambulance]
- R40.2312Coma scale, best motor response, none, at arrival to emergency department
- R40.2313Coma scale, best motor response, none, at hospital admission
- R40.2314Coma scale, best motor response, none, 24 hours or more after hospital admission
- R40.232Coma scale, best motor response, extension
- R40.2320Coma scale, best motor response, extension, unspecified time
- R40.2321Coma scale, best motor response, extension, in the field [EMT or ambulance]
- R40.2322Coma scale, best motor response, extension, at arrival to emergency department
- R40.2323Coma scale, best motor response, extension, at hospital admission
- R40.2324Coma scale, best motor response, extension, 24 hours or more after hospital admission
- R40.233Coma scale, best motor response, abnormal flexion
- R40.2330Coma scale, best motor response, abnormal flexion, unspecified time
- R40.2331Coma scale, best motor response, abnormal flexion, in the field [EMT or ambulance]
- R40.2332Coma scale, best motor response, abnormal flexion, at arrival to emergency department
- R40.2333Coma scale, best motor response, abnormal flexion, at hospital admission
- R40.2334Coma scale, best motor response, abnormal flexion, 24 hours or more after hospital admission
- R40.234Coma scale, best motor response, flexion withdrawal
- R40.2340Coma scale, best motor response, flexion withdrawal, unspecified time
- R40.2341Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance]
- R40.2342Coma scale, best motor response, flexion withdrawal, at arrival to emergency department
- R40.2343Coma scale, best motor response, flexion withdrawal, at hospital admission
- R40.2344Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission
- R40.235Coma scale, best motor response, localizes pain
- R40.2350Coma scale, best motor response, localizes pain, unspecified time
- R40.2351Coma scale, best motor response, localizes pain, in the field [EMT or ambulance]
- R40.2352Coma scale, best motor response, localizes pain, at arrival to emergency department
- R40.2353Coma scale, best motor response, localizes pain, at hospital admission
- R40.2354Coma scale, best motor response, localizes pain, 24 hours or more after hospital admission
- R40.236Coma scale, best motor response, obeys commands
- R40.2360Coma scale, best motor response, obeys commands, unspecified time
- R40.2361Coma scale, best motor response, obeys commands, in the field [EMT or ambulance]
- R40.2362Coma scale, best motor response, obeys commands, at arrival to emergency department
- R40.2363Coma scale, best motor response, obeys commands, at hospital admission
- R40.2364Coma scale, best motor response, obeys commands, 24 hours or more after hospital admission
- R40.24Glasgow coma scale, total score
- R40.241Glasgow coma scale score 13-15
- R40.2410Glasgow coma scale score 13-15, unspecified time
- R40.2411Glasgow coma scale score 13-15, in the field [EMT or ambulance]
- R40.2412Glasgow coma scale score 13-15, at arrival to emergency department
- R40.2413Glasgow coma scale score 13-15, at hospital admission
- R40.2414Glasgow coma scale score 13-15, 24 hours or more after hospital admission
- R40.242Glasgow coma scale score 9-12
- R40.2420Glasgow coma scale score 9-12, unspecified time
- R40.2421Glasgow coma scale score 9-12, in the field [EMT or ambulance]
- R40.2422Glasgow coma scale score 9-12, at arrival to emergency department
- R40.2423Glasgow coma scale score 9-12, at hospital admission
- R40.2424Glasgow coma scale score 9-12, 24 hours or more after hospital admission
- R40.243Glasgow coma scale score 3-8
- R40.2430Glasgow coma scale score 3-8, unspecified time
- R40.2431Glasgow coma scale score 3-8, in the field [EMT or ambulance]
- R40.2432Glasgow coma scale score 3-8, at arrival to emergency department
- R40.2433Glasgow coma scale score 3-8, at hospital admission
- R40.2434Glasgow coma scale score 3-8, 24 hours or more after hospital admission
- R40.244Other coma, without documented Glasgow coma scale score, or with partial score reported
- R40.2440Other coma, without documented Glasgow coma scale score, or with partial score reported, unspecified time
- R40.2441Other coma, without documented Glasgow coma scale score, or with partial score reported, in the field [EMT or ambulance]
- R40.2442Other coma, without documented Glasgow coma scale score, or with partial score reported, at arrival to emergency department
- R40.2443Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission
- R40.2444Other coma, without documented Glasgow coma scale score, or with partial score reported, 24 hours or more after hospital admission
- R40.2ANontraumatic coma due to underlying condition
- R40.3Persistent vegetative state
- R40.4Transient alteration of awareness
R40 MS-DRGs
As the principal diagnosis, the billable codes under R40 group to MS-DRG 951, 080, 081, 791, 793, or 884 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
- DRG 951 Other Factors Influencing Health Status (60 of 101 codes)
- DRG 080 Nontraumatic Stupor and Coma with MCC (40 of 101 codes)
- DRG 081 Nontraumatic Stupor and Coma without MCC (40 of 101 codes)
- DRG 791 Prematurity with Major Problems (38 of 101 codes)
- DRG 793 Full Term Neonate with Major Problems (38 of 101 codes)
- DRG 884 Organic Disturbances and Intellectual Disability (1 of 101 codes)
Other codes that refer to R40
Notes on these codes point to R40.
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
Coma
A coma is a deep state of unconsciousness. An individual in a coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as brain injury.
Read more about coma on MedlinePlusSleep Disorders
While you are sleeping your brain and body functions are still active. Sleep is a natural process that helps your body restore energy, supports learning and memory, and keeps you healthy.
Read more about sleep disorders on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.