Merit-based Incentive Payment System (MIPS) Value Pathway G0057 is titled “Adopting Best Practices and Promoting Patient Safety with Emergency Medicine,” and it focuses on important assessors of the care that emergency clinicians provide to patients with undifferentiated high-risk conditions. One of the Quality Measures (QM) that may be reported for MVP G0057 is QM 415, which is titled “Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older” – minor blunt head trauma includes only non-penetrating injuries.
The numerator options included in the QM 415 specification are used to submit the quality actions as allowed by the measure. “Glasgow Coma Scale (GCS) score less than 15” is one of the numerator options for QM 415.
NUMERATOR:
Emergency department visits for patients who have an indication for a head computed tomography (CT).
Definitions:
Indications for a head CT in patients presenting to the emergency department for minor blunt head trauma:
Patients with no loss of consciousness (LOC) AND no post-traumatic amnesia AND any one of the following:
• GCS score less than 15
• Severe headache
• Vomiting
• Age 65 years and older
• Physical signs of a basilar skull fracture (signs include haemotympanum, “raccoon” eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
• Focal neurological deficit
• Coagulopathy
• Thrombocytopenia
• Currently taking any of the following anticoagulant medications**: apixaban, argatroban, betrixaban, bivalirudin, dabigatran, dalteparin, desirudin, edoxaban, enoxaparin, fondaparinux, heparin, rivaroxaban, warfarin
• Dangerous mechanism of injury (i.e., ejection from a motor vehicle, a pedestrian struck, and a fall from a height of more than 3 feet or 5 stairs)
OR
Patients with either LOC OR posttraumatic amnesia AND any one of the following:
• GCS score less than 15
• Headache
• Age 60 years and older, and less than 65 years
• Drug/alcohol intoxication
• Short-term memory deficits
• Evidence of trauma above the clavicles (physical location, any trauma to the head or neck [i.e., laceration, abrasion, bruising, ecchymosis, hematoma, swelling, fracture])
• Posttraumatic seizure.
**The aforementioned list of medications/drug names is based on clinical guidelines and other evidence and may not be all-inclusive or current. Physicians and other health care professionals should refer to the Food & Drug Administration’s (FDA’s) web site page entitled “Drug Safety Communications” for up-to-date drug recall and alert information when prescribing medications. As part of the measure maintenance process, the measure and specifications will be updated routinely to account for newly released and FDA approved pharmacologic agents.
If “GCS score less than 15” is the indication for a head CT, then the documentation and ICD-10-CM diagnosis coding should support this indication. Key documentation and ICD-10-CM guidelines for reporting GCS scores, and a listing of all GCS score ICD-10-CM diagnosis codes are provided below.
DOCUMENTATION GUIDELINE:
Emergency medical technician (EMT) and other nonphysician documentation of the coma scale can be used for coding. ICD-10-CM diagnosis code assignments are usually based on the documentation by the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis). However, the coma scale is one of the few exceptions, because a GSC score code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis). In this context, “clinicians” other than the patient’s provider refer to healthcare professionals permitted, based on regulatory or accreditation requirements or internal hospital policies, to document in a patient’s official medical record.
ICD-10-CM CODING GUIDELINES:
- A GSC score code from each subcategory (eyes open, best verbal response, best motor response) is needed to complete the scale.
- The 7th character of the code indicates when the scale was recorded.
- The 7th character of the code should match for all three codes (eyes open, best verbal response, best motor response).
- The coma scale code(s) should be sequenced after the diagnosis code(s) [e.g., head trauma code].
- Assign a code from R40.2410 – R40.2434 (Glasgow coma scale, total score), when only the total score is documented in the medical record and not the individual score(s).
- If multiple coma scores are captured within the first 24 hours after hospital admission, assign only the code for the score at the time of admission. NOTE: ICD-10-CM does not classify coma scores that are reported after admission but less than 24 hours later.
- Do not report ICD-10-CM codes for unspecified coma, individual or total Glasgow coma scale scores for a patient with a medically induced coma or a sedated patient.
- At a minimum, report the initial score documented on presentation at the facility. This may be a score from the emergency medicine technician (EMT) or in the emergency department.
- If desired, a facility may choose to capture multiple coma scale scores.
GSC SCORE ICD-10-CM CODES:
| R40.20 Unspecified coma |
| R40.2110 Coma scale, eyes open, never, unspecified time |
| R40.2111 Coma scale, eyes open, never, in the field [EMT or ambulance] |
| R40.2112 Coma scale, eyes open, never, at arrival to emergency department |
| R40.2113 Coma scale, eyes open, never, at hospital admission |
| R40.2114 Coma scale, eyes open, never, 24 hours or more after hospital admission |
| R40.2120 Coma scale, eyes open, to pain, unspecified time |
| R40.2121 Coma scale, eyes open, to pain, in the field [EMT or ambulance] |
| R40.2122 Coma scale, eyes open, to pain, at arrival to emergency department |
| R40.2123 Coma scale, eyes open, to pain, at hospital admission |
| R40.2124 Coma scale, eyes open, to pain, 24 hours or more after hospital admission |
| R40.2130 Coma scale, eyes open, to sound, unspecified time |
| R40.2131 Coma scale, eyes open, to sound, in the field [EMT or ambulance] |
| R40.2132 Coma scale, eyes open, to sound, at arrival to emergency department |
| R40.2133 Coma scale, eyes open, to sound, at hospital admission |
| R40.2134 Coma scale, eyes open, to sound, 24 hours or more after hospital admission |
| R40.2140 Coma scale, eyes open, spontaneous, unspecified time |
| R40.2141 Coma scale, eyes open, spontaneous, in the field [EMT or ambulance] |
| R40.2142 Coma scale, eyes open, spontaneous, at arrival to emergency department |
| R40-2143 Coma scale, eyes open, spontaneous, at hospital admission |
| R40.2144 Coma scale, eyes open, spontaneous, 24 hours or more after hospital admission |
| R40.2210 Coma scale, best verbal response, none, unspecified time |
| R40.2211 Coma scale, best verbal response, none, in the field [EMT or ambulance] |
| R40.2212 Coma scale, best verbal response, none, at arrival to emergency department |
| R40.2213 Coma scale, best verbal response, none, at hospital admission |
| R40.2214 Coma scale, best verbal response, none, 24 hours or more after hospital admission |
| R40.2220 Coma scale, best verbal response, incomprehensible words, unspecified time |
| R40.2221 Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance] |
| R40.2222 Coma scale, best verbal response, incomprehensible words, at arrival to emergency department |
| 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 |
| R40.2230 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 |
| 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 |
| R40.2240 Coma scale, best verbal response, confused conversation, unspecified time |
| R40.2241 Coma scale, best verbal response, confused conversation, in the field [EMT or ambulance] |
| R40.2242 Coma scale, best verbal response, confused conversation, at arrival to emergency department |
| R40.2243 Coma scale, best verbal response, confused conversation, at hospital admission |
| R40.2244 Coma scale, best verbal response, confused conversation, 24 hours or more after hospital admission |
| R40.2250 Coma scale, best verbal response, oriented, unspecified time |
| R40.2251 Coma scale, best verbal response, oriented, in the field [EMT or ambulance] |
| R40.2252 Coma scale, best verbal response, oriented, at arrival to emergency department |
| R40.2253 Coma scale, best verbal response, oriented, at hospital admission |
| R40.2254 Coma scale, best verbal response, oriented, 24 hours or more after hospital admission |
| R40.2310 Coma scale, best motor response, none, unspecified time |
| R40.2311 Coma scale, best motor response, none, in the field [EMT or ambulance] |
| R40.2312 Coma scale, best motor response, none, at arrival to emergency department |
| R40.2313 Coma scale, best motor response, none, at hospital admission |
| R40.2314 Coma scale, best motor response, none, 24 hours or more after hospital admission |
| R40.2320 Coma scale, best motor response, extension, unspecified time |
| R40.2321 Coma scale, best motor response, extension, in the field [EMT or ambulance] |
| R40.2322 Coma scale, best motor response, extension, at arrival to emergency department |
| R40.2323 Coma scale, best motor response, extension, at hospital admission |
| R40.2324 Coma scale, best motor response, extension, 24 hours or more after hospital admission |
| R40.2330 Coma scale, best motor response, abnormal flexion, unspecified time |
| R40.2331 Coma scale, best motor response, abnormal flexion, in the field [EMT or ambulance] |
| R40.2332 Coma scale, best motor response, abnormal flexion, at arrival to emergency department |
| R40.2333 Coma scale, best motor response, abnormal flexion, at hospital admission |
| R40.2334 Coma scale, best motor response, abnormal flexion, 24 hours or more after hospital admission |
| R40.2340 Coma scale, best motor response, flexion withdrawal, unspecified time |
| R40.2341 Coma scale, best motor response, flexion withdrawal, in the field [EMT or ambulance] |
| R40.2342 Coma scale, best motor response, flexion withdrawal, at arrival to emergency department |
| R40.2343 Coma scale, best motor response, flexion withdrawal, at hospital admission |
| R40.2344 Coma scale, best motor response, flexion withdrawal, 24 hours or more after hospital admission |
| R40.2350 Coma scale, best motor response, localizes pain, unspecified time |
| R40.2351 Coma scale, best motor response, localizes pain, in the field [EMT or ambulance] |
| R40.2352 Coma scale, best motor response, localizes pain, at arrival to emergency department |
| R40.2353 Coma scale, best motor response, localizes pain, at hospital admission |
| R40.2354 Coma scale, best motor response, localizes pain, 24 hours or more after hospital admission |
| R40.2360 Coma scale, best motor response, obeys commands, unspecified time |
| R40.2361 Coma scale, best motor response, obeys commands, in the field [EMT or ambulance] |
| R40.2362 Coma scale, best motor response, obeys commands, at arrival to emergency department |
| R40.2363 Coma scale, best motor response, obeys commands, at hospital admission |
| R40.2364 Coma scale, best motor response, obeys commands, 24 hours or more after hospital admission |
| R40.2410 Glasgow coma scale score 13-15, unspecified time |
| R40.2411 Glasgow coma scale score 13-15, in the field [EMT or ambulance] |
| R40.2412 Glasgow coma scale score 13-15, at arrival to emergency department |
| R40.2413 Glasgow coma scale score 13-15, at hospital admission |
| R40.2414 Glasgow coma scale score 13-15, 24 hours or more after hospital admission |
| R40.2420 Glasgow coma scale score 9-12, unspecified time |
| R40.2421 Glasgow coma scale score 9-12, in the field [EMT or ambulance] |
| R40.2422 Glasgow coma scale score 9-12, at arrival to emergency department |
| R40.2423 Glasgow coma scale score 9-12, at hospital admission |
| R40.2424 Glasgow coma scale score 9-12, 24 hours or more after hospital admission |
| R40.2430 Glasgow coma scale score 3-8, unspecified time |
| R40.2431 Glasgow coma scale score 3-8, in the field [EMT or ambulance] |
| R40.2432 Glasgow coma scale score 3-8, at arrival to emergency department |
| R40.2433 Glasgow coma scale score 3-8, at hospital admission |
| R40.2434 Glasgow coma scale score 3-8, 24 hours or more after hospital admission |
| R40.2440 Other coma, without documented Glasgow coma scale score, or with partial score reported, unspecified time |
| R40.2441 Other coma, without documented Glasgow coma scale score, or with partial score reported, in the field [EMT or ambulance] |
| R40.2442 Other coma, without documented Glasgow coma scale score, or with partial score reported, at arrival to emergency department |
| R40.2443 Other coma, without documented Glasgow coma scale score, or with partial score reported, at hospital admission |
| R40.2444 Other coma, without documented Glasgow coma scale score, or with partial score reported, 24 hours or more after hospital admission |
For more information download the MVP G0057, the Quality Measure 415 MIPS CQM Specification, the Official ICD-10-CM Guidelines and/or contact [email protected].