DxCodebookFY2027 · Oct 1, 2026 – Sep 30, 2027

Category · FY2027

R40 Somnolence, stupor and coma

  • Header · not billable
  • Some codes take a 7th character

R40 is not billable. The category heads 101 billable codes in FY2027, grouped under 5 subdivisions.

Index → code

Where it sits

  1. Chapter 18 Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
  2. R40-R46 Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46)
  3. R40 Somnolence, stupor and coma
Billable codes
101
Subdivisions
5
CC / MCC codes
1 / 37
HCC V28 codes
43
New FY2027
0
Index entries
62

Codes in R40

  1. R40.0
    Somnolence
    Billable
    Inclusion terms 1, Excludes1 1

    Inclusion terms

    • Drowsiness

    Excludes1

  2. R40.1
    Stupor
    Billable
    Inclusion terms 2, Excludes1 5

    Inclusion terms

    • Catatonic stupor
    • Semicoma

    Excludes1

    • catatonic schizophrenia (F20.2) F20.2
    • coma (R40.2-) R40.2
    • depressive stupor (F31.-, F32.-, F33.-) F31 F32 F33
    • dissociative stupor (F44.2) F44.2
    • manic stupor (F30.2) F30.2
  3. R40.2
    Coma
    Header
    Notes 1, Code first 3

    Notes

    • One code from each subcategory, R40.21-R40.23, is required to complete the coma scale R40.21 R40.23

    Code first

    • any associated:
    • fracture of skull (S02.-) S02
    • intracranial injury (S06.-) S06
  4. R40.20
    Unspecified coma
    BillableMCC202
    Inclusion terms 2

    Inclusion terms

    • Coma NOS
    • Unconsciousness NOS
  5. R40.21
    Coma scale, eyes open
    Header
  6. R40.211
    Coma scale, eyes open, never +7th: 0 1 2 3 4
    Needs 7th characterMCC 0 1 2 3 4202 (all 7th characters)
    Inclusion terms 1

    Inclusion terms

    • Coma scale eye opening score of 1
  7. R40.212
    Coma scale, eyes open, to pain +7th: 0 1 2 3 4
    Needs 7th characterMCC 0 1 2 3 4202 (all 7th characters)
    Inclusion terms 1

    Inclusion terms

    • Coma scale eye opening score of 2
  8. R40.213
    Coma scale, eyes open, to sound +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 1

    Inclusion terms

    • Coma scale eye opening score of 3
  9. R40.214
    Coma scale, eyes open, spontaneous +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 1

    Inclusion terms

    • Coma scale eye opening score of 4
  10. R40.22
    Coma scale, best verbal response
    Header
  11. R40.221
    Coma scale, best verbal response, none +7th: 0 1 2 3 4
    Needs 7th characterMCC 0 1 2 3 4202 (all 7th characters)
    Inclusion terms 1

    Inclusion terms

    • Coma scale verbal score of 1
  12. R40.222
    Coma scale, best verbal response, incomprehensible words +7th: 0 1 2 3 4
    Needs 7th characterMCC 0 1 2 3 4202 (all 7th characters)
    Inclusion terms 3

    Inclusion terms

    • Coma scale verbal score of 2
    • Incomprehensible sounds (2-5 years of age)
    • Moans/grunts to pain; restless (<2 years old)
  13. R40.223
    Coma scale, best verbal response, inappropriate words +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 3

    Inclusion terms

    • Coma scale verbal score of 3
    • Inappropriate crying or screaming (< 2 years of age)
    • Screaming (2-5 years of age)
  14. R40.224
    Coma scale, best verbal response, confused conversation +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 3

    Inclusion terms

    • Coma scale verbal score of 4
    • Inappropriate words (2-5 years of age)
    • Irritable cries (< 2 years of age)
  15. R40.225
    Coma scale, best verbal response, oriented +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 3

    Inclusion terms

    • Coma scale verbal score of 5
    • Cooing or babbling or crying appropriately (< 2 years of age)
    • Uses appropriate words (2- 5 years of age)
  16. R40.23
    Coma scale, best motor response
    Header
  17. R40.231
    Coma scale, best motor response, none +7th: 0 1 2 3 4
    Needs 7th characterMCC 0 1 2 3 4202 (all 7th characters)
    Inclusion terms 1

    Inclusion terms

    • Coma scale motor score of 1
  18. R40.232
    Coma scale, best motor response, extension +7th: 0 1 2 3 4
    Needs 7th characterMCC 0 1 2 3 4202 (all 7th characters)
    Inclusion terms 3

    Inclusion terms

    • Abnormal extensor posturing to pain or noxious stimuli (< 2 years of age)
    • Coma scale motor score of 2
    • Extensor posturing to pain or noxious stimuli (2-5 years of age)
  19. R40.233
    Coma scale, best motor response, abnormal flexion +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 3

    Inclusion terms

    • Abnormal flexure posturing to pain or noxious stimuli (2-5 years of age)
    • Coma scale motor score of 3
    • Flexion/decorticate posturing (< 2 years of age)
  20. R40.234
    Coma scale, best motor response, flexion withdrawal +7th: 0 1 2 3 4
    Needs 7th characterMCC 0 1 2 3 4
    Inclusion terms 2

    Inclusion terms

    • Coma scale motor score of 4
    • Withdraws from pain or noxious stimuli (2-5 years of age)
  21. R40.235
    Coma scale, best motor response, localizes pain +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 3

    Inclusion terms

    • Coma scale motor score of 5
    • Localizes pain (2-5 years of age)
    • Withdraws to touch (< 2 years of age)
  22. R40.236
    Coma scale, best motor response, obeys commands +7th: 0 1 2 3 4
    Needs 7th character
    Inclusion terms 3

    Inclusion terms

    • Coma scale motor score of 6
    • Normal or spontaneous movement (< 2 years of age)
    • Obeys commands (2-5 years of age)
  23. R40.24
    Glasgow coma scale, total score
    Header
    Notes 1

    Notes

    • Assign a code from subcategory R40.24, when only the total coma score is documented R40.24
  24. R40.241
    Glasgow coma scale score 13-15 +7th: 0 1 2 3 4
    Needs 7th character
  25. R40.242
    Glasgow coma scale score 9-12 +7th: 0 1 2 3 4
    Needs 7th character
  26. R40.243
    Glasgow coma scale score 3-8 +7th: 0 1 2 3 4
    Needs 7th character202 (all 7th characters)
  27. R40.244
    Other coma, without documented Glasgow coma scale score, or with partial score reported +7th: 0 1 2 3 4
    Needs 7th character202 (all 7th characters)
  28. R40.2A
    Nontraumatic coma due to underlying condition
    BillableMCC202
    Inclusion terms 1, Excludes1 4, Code first 1

    Inclusion terms

    • Secondary coma

    Excludes1

    • coma scale, best motor response (R40.24.-) R40.24
    • coma scale, best verbal response (R40.22.-) R40.22
    • coma scale, eyes open (R40.21.-) R40.21
    • Glasgow coma scale, total score (R40.23.-) R40.23

    Code first

    • underlying condition
  29. R40.3
    Persistent vegetative state
    BillableCC202
  30. R40.4
    Transient alteration of awareness
    Billable

CC/MCC: as a secondary diagnosis, unless the principal diagnosis is on the code’s PDX exclusion list (MS-DRG v44 Appendix C; list on the code card).

Sources of each column. Rows marked +7th need a 7th character: pick one to build the full code; its code card has its own flags.

Instructions

At R40

Excludes1

  • neonatal coma (P91.5) P91.5
  • somnolence, stupor and coma in diabetes (E08-E13) E08 E13
  • somnolence, stupor and coma in hepatic failure (K72.-) K72
  • somnolence, stupor and coma in hypoglycemia (nondiabetic) (E15) E15

Notes that also apply

Block R40-R46 instructions (Excludes2 1): printed on the block page.

Chapter 18 instructions (Notes 9, Excludes2 4): printed on the chapter 18 page.

7th characters

7th characters for R40.21 defined at R40.21

The following appropriate 7th character is to be added to subcategory R40.21-:

7th characters for R40.21
7thMeaning (NCHS)
0unspecified time
1in the field [EMT or ambulance]
2at arrival to emergency department
3at hospital admission
424 hours or more after hospital admission

7th characters for R40.22 defined at R40.22

The following appropriate 7th character is to be added to subcategory R40.22-:

7th characters for R40.22
7thMeaning (NCHS)
0unspecified time
1in the field [EMT or ambulance]
2at arrival to emergency department
3at hospital admission
424 hours or more after hospital admission

7th characters for R40.23 defined at R40.23

The following appropriate 7th character is to be added to subcategory R40.23-:

7th characters for R40.23
7thMeaning (NCHS)
0unspecified time
1in the field [EMT or ambulance]
2at arrival to emergency department
3at hospital admission
424 hours or more after hospital admission

7th characters for R40.24 defined at R40.24

The following appropriate 7th character is to be added to subcategory R40.24-:

7th characters for R40.24
7thMeaning (NCHS)
0unspecified time
1in the field [EMT or ambulance]
2at arrival to emergency department
3at hospital admission
424 hours or more after hospital admission

A code that takes a 7th character is invalid without it; the placeholder X fills a code shorter than 6 characters (Official Guidelines I.A.5). How 7th characters work.

Index entries

  • Drowsiness → R40.0
  • Somnolence → R40.0
  • Clouded state → R40.1
  • Semicoma → R40.1
  • Stupor (catatonic) → R40.1
  • Coma → R40.20
  • Catatonicstupor → R40.1
  • Comaspecified NEC, without documented Glasgow coma scale score, or with partial Glasgow coma scale score reported → R40.244
  • Comanontraumatic, due to underlying condition → R40.2A
  • Comasecondary → R40.2A
  • Comapersistent vegetative state → R40.3
  • State (of)persistent vegetative → R40.3
  • State (of)vegetative, persistent → R40.3
  • Comawithopening of eyes (never) → R40.211
  • Comawithverbal response (none) → R40.221
  • Comawithmotor response (none) → R40.231
  • Glasgow coma scaletotal score13-15 → R40.241
  • Glasgow coma scaletotal score9-12 → R40.242
  • Glasgow coma scaletotal score3-8 → R40.243
  • Alteration (of), Alteredawarenesstransient → R40.4
  • Comawithopening of eyes (never)spontaneous → R40.214
  • Comawithverbal response (none)incomprehensible sounds (2-5 years of age) → R40.222
  • Comawithverbal response (none)incomprehensible words → R40.222
  • Comawithverbal response (none)moans/grunts to pain; restless (<2 years old) → R40.222
  • Comawithverbal response (none)inappropriate crying or screaming (< 2 years of age) → R40.223
  • Comawithverbal response (none)inappropriate words → R40.223
  • Comawithverbal response (none)screaming (2-5 years of age) → R40.223
  • Comawithverbal response (none)confused conversation → R40.224
  • Comawithverbal response (none)inappropriate words (2-5 years of age) → R40.224
  • Comawithverbal response (none)irritable cries (< 2 years of age) → R40.224
  • Comawithverbal response (none)cooing or babbling or crying appropriately (< 2 years of age) → R40.225
  • Comawithverbal response (none)oriented → R40.225
  • Comawithverbal response (none)uses appropriate words (2- 5 years of age) → R40.225
  • Comawithmotor response (none)abnormal extensor posturing to pain or noxious stimuli (< 2 years of age) → R40.232
  • Comawithmotor response (none)extension → R40.232
  • Comawithmotor response (none)extensor posturing to pain or noxious stimuli (2-5 years of age) → R40.232
  • Comawithmotor response (none)abnormal → R40.233
  • Comawithmotor response (none)abnormal flexure posturing to pain or noxious stimuli (0-5 years of age) → R40.233
  • Comawithmotor response (none)flexion/decorticate posturing (< 2 years of age) → R40.233
  • Comawithmotor response (none)flexion withdrawal → R40.234

22 more, longer entries are not listed; the search box finds them by word.

NCHS Alphabetic Index. Index first, then the Tabular List.

Hierarchy