Q&A: Glasgow Coma Scale and HCCs

Q: I’ve been told that a patient with the documentation of “traumatic cerebral edema with loss of consciousness of 18 hours and Glasgow Coma Scale (GCS)—eyes open to sound,” should be assigned to HCC 166. But I keep coming up with two possible HCCs for this situation and am not sure why HCC 166 is the correct one. Code R40.2430, Glasgow coma scale score 3-8, unspecified time, leads to HCC 80. Code S06.1X4A, Traumatic cerebral edema with loss of consciousness of 6-24 hours, initial encounter, however, leads to HCC 166. Should we always assign the most severe (and therefore higher-weighted) HCC?

A: The reason this patient would be assigned to HCC 166 actually has to do with the directions located under the code for GCS. When you look up code R40.24, Glasgow coma scale, initial score, the directions underneath it read:

Note: Assign a code from subcategory R40.24, when only the total coma score is documented.

You are correct that code R40.213-, Coma scale, eyes open to sound, has a note that states “Coma scale, eyes opening to score of 3,” but the total score was not documented in the information you provided. It only states “GCS—eyes open to sound,” so the correct answer is HCC 166, based off of code S06.1X4A leading to HCC 166.

Editor’s Note: Sharme Brodie, RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps, click here.