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Neurology & Pain Management Coding Alert


New Dx Class Specifies Stroke Scale Scores

Report NIHSS results with one of 42 new codes.

When ICD-10 2017 took effect in October 2016, coders were finally able to report National Institutes of Health Stroke Scale (NIHSS) scores for patients who took the assessment.

This made reporting the results of the stroke test far more specific, allowing the physician to paint a more precise picture of the patient’s condition.

Read on for a primer on the NIHSS code set, and some expert input on how it will affect coding and patient care.

Now, There’s An ICD-10 for Each Scale Score

ICD-10 2017 features 43 NIHSS-specific codes in the R29.- (Other symptoms and signs involving the nervous and musculoskeletal system) code set. The scale features a 42-point scoring system, and each score from 0 to 42 has its own code.

The scale score codes are R29.700 (NIHSS score 0) through R29.742 (NIHSS score 42). The higher the score, the more severe and devastating the stroke.

Impact: “This type of specificity can enhance the use of administrative databases to perform outcomes research,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison. “The lack of clinical information in administrative databases has been the biggest obstacle to providing easily accessible clinical and treatment information from a single searchable source.”

Physicians Use NIHSS to Guide Px Care

The provider performs the NIHSS to quantify the severity of ischemic strokes and make an objective assessment of the condition of the patient. The scale is a 15-item exam, vetted by the American Heart Association and the American Stroke Association, to assess the neurological status. The assessment includes level of consciousness, motor skills, facial palsy, limb ataxia, language, best gaze, and visual fields.