Neurology & Pain Management Coding Alert

Question: I-m having a hard time understanding the new ICD-9 sleep codes beginning with 327. When should I be using these codes instead of the old 780.5 series?


Connecticut Subscriber


Answer: With the addition of the new organic sleep disorder category, the sleep disturbance codes 780.51-780.59 were all changed to indicate unspecified diagnoses.

You should only use the 780.5x series of codes if the following, more specific, classifications are not appropriate:

- Nonorganic sleep disorders (307.40-307.49)
- Circadian rhythm sleep disorders (327.30-327.39)
- Organic insomnia (327.00-327.09)
- Organic hypersomnia (327.10-327.19)
- Organic sleep apnea (327.20-327.29)
- Parasomnias (327.40-327.49)
- Organic sleep-related movement disorders (327.51-327.59)
- Alcohol- or drug-induced disorders (291.82, 292.85)
- Restless leg syndrome (333.99). Rule of thumb: One big source of confusion comes from understanding the definition of an -organic- sleep disorder. To gain some clarity on this term, it is probably easiest to remember what organic disorders don't include, namely emotional or drug/alcohol-induced causes.

When using the new sleep diagnoses, you also need to be careful of the sequencing. You-ll order the organic sleep disorder code as secondary whenever you are reporting a diagnosis resulting from other mental or medical conditions.

Example: A patient with paraphrenia (297.2) presents for sleep testing after experiencing insomnia. You would use 297.2 as your primary diagnosis, followed by 327.02 (Insomnia due to mental disorder). Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J; and Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver.