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FAQ: Coding NIHSS Scores

Published on 

Wednesday, June 9, 2021

 | FAQ 

What is the significance of coding the National Institutes of Health Stroke Scale Scores (NIHSS) that were implemented in 2017?


The NIHSS is a neurological exam that is scored on all acute stroke patients. The provider or clinician will calculate and document the score. The coder is to assign R29.7—based on the score or scores.

Score Description
0 No Stroke
1-4 Minor Stroke
5-15 Moderate Stroke
16-20 Moderate/Severe Stroke
21-24 Severe Stroke

CMS has been gathering claims data on strokes from July 1, 2018 - June 30, 2021 which will be publically reported in FY 2022. For FY 2023 the data will start affecting hospital reimbursement as part of the 30-Day Stroke Mortality Measure. Hospitals should report the first NIHSS, which is typically documented after arrival to the hospital along with the appropriate stroke code. You may report additional NIHSS codes and use the POA indicator No for those additional codes.

In a recent Wednesday@One article (link) and related Infographic, RTMD’s claims data revealed only 40.1% of the claims included an NIHSS code. The reason the reporting of the NIHSS codes is so low may be due to the wording of the coding guideline. The guideline states, codes R29.7—may be used in conjunction with the stroke codes, so many hospitals are opting not to code them.

The main point of this article is to make sure you always report a NIHSS code with an acute stroke code and that they appear on the claim. Omitting the R29.7- code will adversely impact your hospital’s future reimbursement.

Coding Clinic, Fourth Quarter 2016, page 61
NIHSS Stroke Scale, ICD-10-CM Coding Guidelines
Article Author: Anita Meyers, RHIT, CCS
Anita Meyers, RHIT, CCS, is an Inpatient Coding Professional at Medical Management Plus. Anita has over twenty-six years of experience in inpatient and outpatient coding including 17 years of work at AQAF reviewing inpatient and outpatient records from Alabama hospitals. In addition to reviewing records she was the team leader in Beneficiary Services where she participated in case review activities, received and processed beneficiary complaints and handled fee-for-service denials for home health, hospice and skilled nursing facility services. Prior to joining the MMP team, Anita left AQAF to become an inpatient contract coder and worked at various hospitals in central Alabama. In her current position, Anita is an integral part of the Inpatient Services at Medical Management Plus.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.