Neurology & Pain Management Coding Alert

Turn to G47.30 for unspecified sleep apnea and G47.9 for unspecified sleep disorder.

When your neurologist reports a cause for sleep apnea (such as an obstruction - an airway blockage that occurs when the soft tissue in the back of the throat narrows or closes during sleep), you currently report 327.23 (Obstructive sleep apnea [adult] [pediatric]). The corresponding ICD-10 code is G47.33 (Obstructive sleep apnea [adult] [pediatric]). But what if your physician doesn’t document a specific cause for the sleep apnea? You need to report ‘unspecified sleep apnea’ but should understand all the factors to consider when reporting this ambiguous condition – under either ICD-9 or ICD-10.

You Have Specific Code for ‘Unspecified’

When your neurologist is not able to identify the cause for sleep apnea or is still trying to find one, you report ICD-9 code 780.57 (Unspecified sleep apnea) for the unspecified sleep apnea. You’ll have a simple one-to-one match in ICD-10 with corresponding code G47.30 (Sleep apnea, unspecified).

Ignore the Associated Sleep Condition

Sleep apnea is a common cause for disturbed sleep even if the cause for the sleep apnea remains undetermined. Your neurologist may document several episodes of night time awakening and insomnia. In some instances, the patient might complain of excessive daytime sleepiness, a characteristic of hypersomnia.

When your physician documents sleep apnea with either insomnia or hyposomnia, report ICD-9 code 780.51 (Insomnia with sleep apnea, unspecified). If however, your physician documents sleep apnea with hypersomnia, you report ICD-9 code 780.53 (Hypersomnia with sleep apnea, unspecified). Both these ICD-9 codes map to ICD-10 code G47.30, irrespective of how the condition affects the patient’s sleep.

Look For Simple Match for ‘Unspecified’ Sleep Conditions

When your physician documents disturbed sleep, submit ICD-9 code 780.50 (Unspecified sleep disturbance). The corresponding ICD-10 code is G47.9 (Sleep disorder, unspecified).

Sometimes, however, your physician may fail to find a specific cause for insomnia and hypersomnia. For unspecified insomnia, report ICD-9 code 780.52 (Insomnia, unspecified) and for unspecified hypersomnia, you report 780.54 (Hypersomnia, unspecified). The corresponding ICD-10 codes for these conditions are G47.00 (Insomnia, unspecified) and G47.10 (Hypersomnia, unspecified), respectively.

In some cases, the patient may be diagnosed with a disturbance in the sleep/wake cycle, but a cause might not be precisely established. In this case, report ICD-9 code 780.55 (Disruption of 24 hour sleep wake cycle unspecified).

The corresponding ICD-10 code G47.20 (Circadian rhythm sleep disorder, unspecified type) uses more applicable term ‘circadian rhythm.’ This is the endogenous entrainable 24-hour rhythm of sleep and wakefulness. The ICD-10 descriptor has a better explanation of disruption of the sleep/wake cycle.

Watch for Chances to Report ‘Other’ Sleep Disorders

ICD-10 isn’t specific for sleep stage dysfunction or difficulty in arousal from sleep. In ICD-9, you report code 780.58 (Sleep related movement disorder, unspecified) but in ICD-10 the corresponding choice is F51.8 (Other sleep disorders not due to a substance or known physiological condition). ICD-10 isn’t as specific as ICD-9 for the unspecified sleep related movement disorders are reported as ‘other’ sleep disorders.

Definition: Sleep related movement disorders are non-purposeful, simple, stereotype movements that can disrupt sleep. Some examples of this condition include movements in legs, say sleep related leg cramps and restless legs syndrome or movement in the jaw, i.e., sleep related bruxism. Another example can be sleep-related rhythmic movement disorder.

The ICD-10 code for “other” sleep disorders, G47.8 (Other sleep disorders), maps to ICD-9 codes 780.56 (Dysfunctions associated with sleep stages or arousal from sleep) and 780.59 (Other sleep disturbances). Hence, in ICD-10, you report sleep stage and arousal disturbances as “other’ sleep disorders.