R40.2232 Coma scale, best verbal response, inappropriate words, at arrival to emergency department

Billable ICD-10-CM code, FY2026.

Built from R40.223 with 7th character 2 (at arrival to emergency department).

Applies from R40 Somnolence, stupor and coma

Excludes1 (never code together)

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

Applies from R40.2 Coma

Code first

• any associated:
• fracture of skull (S02.-)
• intracranial injury (S06.-)

Notes

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

Applies from R40.22 Coma scale, best verbal response

7th character note

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

7th character required

• 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

Applies from R40.223 Coma scale, best verbal response, inappropriate words

Applicable to

• Coma scale verbal score of 3
• Inappropriate crying or screaming (< 2 years of age)
• Screaming (2-5 years of age)

Medicare Code Edits (MCE v43.1 (April 2026))

• Unacceptable principal diagnosis: These codes describe a circumstance which influences care but is not a current illness or injury, or capture only an underlying condition, and are unacceptable as principal diagnosis.

Code annotations containing back-references to R40.2232

Back-references to R40.22

• Type 1 Excludes: R40.2A Nontraumatic coma due to underlying condition ("coma scale, best verbal response (R40.22.-)")

Back-references to R40.2

• Type 1 Excludes: R40.0 Somnolence ("coma (R40.2-)")
• Type 1 Excludes: R40.1 Stupor ("coma (R40.2-)")
• Type 1 Excludes: R55 Syncope and collapse ("unconsciousness NOS (R40.2-)")

Back-references to R40

• Type 1 Excludes: R41.82 Altered mental status, unspecified ("altered level of consciousness (R40.-)")
• Use Additional: T67.0 Heatstroke and sunstroke ("coma and stupor (R40.-)")

Diagnosis Index entries for R40.2232

• Coma › with › verbal response (none) › inappropriate crying or screaming (< 2 years of age)
• Coma › with › verbal response (none) › inappropriate words
• Coma › with › verbal response (none) › score of › 3
• Coma › with › verbal response (none) › screaming (2-5 years of age)

Nearby codes

• R40.2223 Coma scale, best verbal response, incomprehensible words, at hospital admission
• R40.2224 Coma scale, best verbal response, incomprehensible words, 24 hours or more after hospital admission
• R40.223 Coma scale, best verbal response, inappropriate words
• R40.2230 Coma scale, best verbal response, inappropriate words, unspecified time
• R40.2231 Coma scale, best verbal response, inappropriate words, in the field [EMT or ambulance]
• R40.2232 Coma scale, best verbal response, inappropriate words, at arrival to emergency department (this code)
• R40.2233 Coma scale, best verbal response, inappropriate words, at hospital admission
• R40.2234 Coma scale, best verbal response, inappropriate words, 24 hours or more after hospital admission
• R40.224 Coma scale, best verbal response, confused conversation
• R40.2240 Coma scale, best verbal response, confused conversation, unspecified time
• R40.2241 Coma scale, best verbal response, confused conversation, in the field [EMT or ambulance]