Neurosurgery Coding Alert

In addition to scores, timing becomes crucial for the right GCS code.

In the last issue of the Neurosurgery Coding Alert, you had a chance to review the NIHSS codes. Another similar scale used for neurological assessment is the Glasgow Coma Scale. When these updates are implemented, you will continue to check the GCS score that your surgeon has documented. In addition, the timing of the assessment will become crucial. Read more about what lies ahead for GCS coding.

Keep Track of Time for GCS

You will have definitive codes for minor, moderate, and severe brain injuries based on the time of assessment of brain function.

What is new? ICD-10 emphasizes the importance of timing of GCS assessment. Later this year, you can expect to see new codes that will necessitate documentation of ‘when exactly’ the GCS assessments were done. You will choose from codes depending upon GCS assessments for the following events:

• Upon arrival to emergency department
• At hospital admission
• 24 hours or more after hospital admission

Additionally, you will also be able to submit a code when the time of GCS assessment is not specified.

What you can continue to do? You will continue to pick up the ICD-10 codes depending upon the score of GCS.

“When the Glasgow Coma Score was originally developed, the timing of the assessment was a critical component,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.  “It was also intended to be used in an early assessment and follow-up assessment to help predict the likelihood of a significant injury that would potentially require an invasive surgical treatment.  Similar to the NIHSS coding specificity, this information provided through an administrative database can facilitate outcomes research.”

Look For New Codes

Later this year, you can anticipate deletions and new codes for GCS.

What will be deleted? The following codes will be deleted for GCS:

• R40.241, Glasgow coma scale score 13-15
• R40.242, Glasgow coma scale score 9-12
• R40.243, Glasgow coma scale score 3-8
• R40.244, Other coma, without documented Glasgow coma scale score, or with partial score reported

New code options: Depending upon the GCS scores and timing of assessment, you will be able to choose form the following new codes:

GCS score 13-15

• R40.2410, Glasgow coma scale score 13-15, unspecified time
• R40.2411, …….in the field [EMT or ambulance]
• R40.2412, ….. at arrival to emergency department
• R40.2413, …… at hospital admission
• R40.2414, ….. 24 hours or more after hospital admission

GCS score 9-12

• R40.2420, Glasgow coma scale score 9-12, unspecified time
• R40.2421, ….. in the field [EMT or ambulance]
• R40.2422, ….. at arrival to emergency department
• R40.2423, ….. at hospital admission
• R40.2424, ….. 24 hours or more after hospital admission

GCS score 3-8

• R40.2430, Glasgow coma scale score 3-8, unspecified time
• R40.2431, ….. in the field [EMT or ambulance]
• R40.2432, ….. at arrival to emergency department
• R40.2433, …… at hospital admission
• R40.2434, ….. 24 hours or more after hospital admission

Don’t Let Go Partial Glasgow Scores

If your physician documents only part of the assessments for GCS or does not document any GCS scores at all, you can choose form the following codes:

• R40.2440, Other coma, without documented Glasgow coma scale score, or with partial score reported, unspecified time
• R40.2441, …in the field [EMT or ambulance]
• R40.2442, ….. at arrival to emergency department
• R40.2443, ….. at hospital admission
• R40.2444, …..24 hours or more after hospital admission.

Gain Confidence For Basics Of GCS

The Glasgow Coma Scale (GCS): The GCS is used to assess the magnitude of brain injury. Elements of the scale include eye opening, verbal response, and best motor response. 

Scoring on GCS: There are 4 scores for eye opening (1 for does not open opens; 4 for opens eyes spontaneously), 5 for verbal response (1 for makes no sound; 5 for oriented converses normally), and 6 for motor response (1 for makes no movements; 6 for obeys commands). The lowest possible GCS score is 3 (deep coma or death) and the highest is 15 (fully awake person). 

Assessment of brain damage on GCS: Scores of 13 or higher, 9-12, and 3-8 are indicative of minor, moderate, and severe brain injury, respectively. 

Find the scales: You can take a look at the scale on: http://www.glasgowcomascale.org/downloads/GCS-Assessment-Aid-English.pdf.