New GCS Guideline??
ICD-10-CM Official Guidelines for Coding and Reporting FY 2020 (October 1, 2019 - September 30, 2020)
C. Chapter-Specific Coding Guidelines
18. Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
e. Coma scale
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes, acute cerebrovascular disease or sequelae of cerebrovascular disease codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition. The coma scale codes should be sequenced after the diagnosis code(s).
vs.
ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 (October 1, 2020 - September 30, 2021)
C. Chapter-Specific Coding Guidelines
18. Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
e. Coma scale
The coma scale codes (R40.2-) can be used in conjunction with traumatic brain injury codes. These codes are primarily for use by trauma registries, but they may be used in any setting where this information is collected. The coma scale codes should be sequenced after the diagnosis code(s).
Does anyone interpret this as GCS are "no longer allowed for non traumatic brain injuries?"
What about anoxic brain damage due to other causes… i.e. overdose?
Thank you.
Comments
I copied this statement from the guidelines you cited:
The coma scale may also be used to assess the status of the central nervous system for other non-trauma conditions, such as monitoring patients in the intensive care unit regardless of medical condition
The 2021 guideline has several deleted sections. See: ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 Page 78 of 126. e. Coma scale.
This was one of our topics today during our monthly CDI and Coding Quality meeting. Based upon the new 2021 guideline, we will only assign the coma scale codes in conjunction with TBI codes.
I was wondering the same thing. This will make a huge impact. Does the words "...but they may be used in any setting where this information is collected" mean it can still be coded with CVA's, etc....?
I came to the Forum today to look for this exact conversation! I've heard varying advice. The part quoted by JoMullins above sticks out to me as well "but they may be used in any setting where this information is collected". To me, that says if they are documented - you can capture them. Sounds like we need a coding clinic or some type of clarification!!
I submitted a question to Coding Clinic with the request to please publish the response about this very question. We had a patient who was s/p cardiopulmonary arrest in the field who was intubated prior to arrival but never required sedation and was extubated on day 2 and transitioned to comfort measures with diagnosed "anoxic brain injury" and survived for 7 days post event but never responded to any purposeful extent. GCS ranged from 0 to 6 at best. To code or not to code?
I'll post their response when it returns. Last response took well over 6 months though. That's a lot of revenue and SOI/ROM at stake until then.
Did you get any response to your question?
Shelly
We submitted a related question back in September and we received this response from AHA:
This letter is in response to your request for clarification regarding assignment of the Glasgow coma scale (GCS) in a patient with seizure activity or in a post-ictal state.
Based on the current guidelines, it is appropriate to assign a GCS code when the coma scale score is documented by the provider for facilities that wish to capture this information. The GCS scores are assigned to provide additional information when a patient has been diagnosed with a central nervous system condition.
However, please note that there is a guideline change effective October 1, 2020. Effective October 1, GCS codes can only be used in conjunction with traumatic brain injury codes.