R40.223 vs R40.2230
R40.223 (Coma scale, best verbal response, inappropriate words) compared with R40.2230 (Coma scale, best verbal response, inappropriate words, unspecified time), from the official CMS tabular data.
Summary
These codes represent different levels of the same hierarchy: R40.223 is the non-billable header that contains R40.2230, so only R40.2230 (or a sibling) is reported.
Registry fact- What is different?
Title wording and billing status.R40.2230’s title adds “unspecified time” to the wording the two share (“Coma scale, best verbal response, inappropriate words”). R40.223 is a non-billable header; R40.2230 is billable.
Registry fact
- Can these codes be reported together?
Not as a pair.R40.223 is the non-billable header that contains R40.2230. A header is not reported on a claim, so the choice is R40.2230 or a sibling that matches the documentation.
Registry fact
- Is there an Excludes1 relationship?
None.Neither entry carries an Excludes1 note that names the other code. R40.223 carries 4 Excludes1 notes and R40.2230 carries 4 Excludes1 notes covering other codes; the side-by-side table quotes them.
Official rule
- Is there an Excludes2 relationship?
None.Neither entry carries an Excludes2 note that names the other code. R40.223 carries 1 Excludes2 note and R40.2230 carries 1 Excludes2 note covering other codes; the side-by-side table quotes them.
Official rule
- Is one more specific?
Yes.R40.2230 is a subdivision of R40.223 in the tabular hierarchy, so it is the more specific of the two.
Registry fact
- Is one a parent or header code?
Yes.R40.223 is the non-billable header that contains R40.2230. A header stands for the whole family beneath it and is not reported on a claim.
Registry fact
- Are there sequencing instructions?
None.Neither entry carries a Code First or Use Additional Code note that names the other.
Official rule
- Are there other coding relationships?
None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.
MedCoder-derived
Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels
Can these codes be reported together?
Not as a pair — R40.223 is not reportable. R40.223 is the non-billable category that contains R40.2230.
A header stands for the whole family of codes beneath it and is not reported on a claim, so the choice is R40.2230 or a sibling that matches the documentation. No Excludes1/Excludes2 relationship exists between these codes in the official tabular list.
Official guidance behind these answers
Section I.B.2 — Level of Detail in Coding · applies to: R40.223 and R40.2230
Diagnosis codes are to be used and reported at their highest number of characters available and to the highest level of specificity documented in the medical record. ICD-10-CM diagnosis codes are composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth characters and/or sixth characters, which provide greater detail. A three-character code is to be used only if it is not further subdivided. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable.
ICD-10-CM Official Guidelines FY2026
Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum
Side by side
| R40.223Coma scale, best verbal response, inappropriate words | R40.2230Coma scale, best verbal response, inappropriate words, unspecified time | |
|---|---|---|
| Billing status | Non-billable header Report instead: R40.2230, R40.2231, R40.2232, R40.2233, R40.2234 | Billable |
| Classification | R00-R99 — Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) | R00-R99 — Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) |
| Definition | Coma scale, best verbal response, inappropriate words is a non-billable ICD-10-CM category code (R40.223). | Coma scale, best verbal response, inappropriate words, unspecified time is a billable ICD-10-CM diagnosis code (R40.2230). |
| 7th character | The following appropriate 7th character is to be added to subcategory R40.22-: | The following appropriate 7th character is to be added to subcategory R40.22-: |
| Includes | Coma scale verbal score of 3 Inappropriate crying or screaming (< 2 years of age) Screaming (2-5 years of age) | Coma scale verbal score of 3 Inappropriate crying or screaming (< 2 years of age) Screaming (2-5 years of age) |
| Excludes1 | 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) | 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) |
| Excludes2 | symptoms and signs constituting part of a pattern of mental disorder (F01-F99) | symptoms and signs constituting part of a pattern of mental disorder (F01-F99) |
| Code first | any associated: fracture of skull (S02.-) | any associated: fracture of skull (S02.-) |
Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.
Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources