ED Coding and Reimbursement Alert

Question: A patient comes to the ED reporting that shortly after waking up in the morning, it is extremely difficult for him to move his arms and legs. The patient says this has been happening "off and on" for about three weeks, but this episode was especially intense. He also reports mild hallucinations during these times of "paralysis." The physician diagnoses sleep paralysis during a level-four E/M. I have pored over the sleep disorder ICD-9 code set (327.XX) and cannot find a diagnosis. Should I code the patient's symptoms? North Carolina Subscriber Answer: There is an ICD-9-CM code for sleep paralysis. The proper code for this patient's condition is 327.43 (Recurrent isolated sleep paralysis). On the claim, append 327.43 to 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity).