ICD-10 Coding for Unresponsive Episode(R40.20, G40.301, E11.641)
Complete ICD-10-CM coding and documentation guide for Unresponsive Episode. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Unresponsive Episode
R40-R46Primary Range
Symptoms and signs involving cognition, perception, emotional state and behavior
Includes codes for altered mental status, coma, and related symptoms.
Diabetes mellitus
Includes codes for hypoglycemic coma, relevant for metabolic causes of unresponsiveness.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R40.20 | Unspecified coma | Use when unresponsiveness persists for more than 1 hour without a transient cause. |
|
| G40.301 | Generalized idiopathic epilepsy with status epilepticus | Use for unresponsiveness during prolonged seizures with EEG confirmation. |
|
| E11.641 | Hypoglycemic coma | Use when unresponsiveness is due to hypoglycemia confirmed by lab results. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for unresponsive episode
Essential facts and insights about Unresponsive Episode
Primary ICD-10-CM Codes for unresponsive episode
Decision Criteria
clinical Criteria
- GCS ≤8 and duration >1 hour
Applicable To
- Coma NOS
Excludes
- Transient alteration of awareness (R40.4)
Clinical Validation Requirements
- GCS ≤8
- Duration >1 hour
- Exclusion of transient causes
Code-Specific Risks
- Incorrect use for brief unresponsiveness
Coding Notes
- Ensure documentation supports the duration and severity of coma.
G40.301 - Generalized idiopathic epilepsy with status epilepticus
Use for unresponsiveness during prolonged seizures with EEG confirmation.
Applicable To
- Status epilepticus
Excludes
- Non-epileptic seizures
Clinical Validation Requirements
- EEG showing generalized spike-wave activity
Coding Notes
Ensure EEG findings are documented to support the code.
E11.641 - Hypoglycemic coma
Use when unresponsiveness is due to hypoglycemia confirmed by lab results.
Applicable To
- Diabetic coma due to hypoglycemia
Excludes
- Hyperglycemic coma
Clinical Validation Requirements
- Glucose <50 mg/dL
- Rapid reversal with dextrose
Coding Notes
Document exact glucose levels and response to treatment.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Personal history of seizures
Z86.73Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Unresponsive Episode to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R40.20.
Impact
Clinical: Misdiagnosis risk, Regulatory: Non-compliance with coding standards, Financial: Denied claims
Mitigation Strategy
Always check and document glucose levels, Use templates to ensure completeness
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Potential audit risk, Data Quality: Inaccurate clinical data
Mitigation Strategy
Use R40.4 for transient episodes <1 hour.
Impact
Using R40.20 without sufficient documentation.
Mitigation Strategy
Ensure detailed documentation of GCS and duration.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Unresponsive Episode, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Unresponsive Episode
Use these documentation templates to ensure complete and accurate documentation for Unresponsive Episode. These templates include all required elements for proper coding and billing.
Emergency Department Evaluation
Specialty: Emergency MedicineRequired Elements
- Baseline mental status
- Current GCS
- Duration of unresponsiveness
- Associated findings
- Confirmatory testing
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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