R40-R46 — Symptoms and signs involving cognition, perception, emotional state and behavior
ICD-10-CM codes R40-R46 cover symptoms and signs involving cognition, perception, emotional state and behavior, within symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified. The block holds 192 codes across 7 categories, of which 157 are billable and 35 are header codes that cannot be submitted on a claim. 118 of them (61%) require a 7th character.
The 7th character in R40-R46
A code in this block is not complete without its 7th character, and a missing one is a rejected claim rather than a denied one: the clearinghouse never passes it on. 118 of the 192 codes here take one.
- 0
- unspecified time
- 1
- in the field [EMT or ambulance]
- 2
- at arrival to emergency department
- 3
- at hospital admission
- 4
- 24 hours or more after hospital admission
Risk adjustment in R40-R46
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 202 Coma, Brain Compression/Anoxic Damage
- HCC 155 Major Depression, Moderate or Severe, without Psychosis
What else to watch in R40-R46
- 148 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in R40-R46
- R40Somnolence, stupor and coma
- R41Other symptoms and signs involving cognitive functions and awareness
- R42Dizziness and giddiness
- R43Disturbances of smell and taste
- R44Other symptoms and signs involving general sensations and perceptions
- R45Symptoms and signs involving emotional state
- R46Symptoms and signs involving appearance and behavior