Pulmonology Coding Alert

Question: We keep facing denials for our sleep terrors, sleepwalking, and idiopathic hypersomnia codes because we are using psychiatric codes. Should we report other codes to have our claims accepted?

New York Subscriber

Answer: Codes that fall within the "mental disorders" category of ICD-9 are sometimes denied for payment because carriers consider them under the "behavioral health" component of insurance rather than the "medical" component. 

You should instead consider reporting diagnoses from the "sleep disturbance" section of ICD-9 manual (780.50-780.59).  

Since psychiatric codes have such a significant impact on a patient's insurance and personal profile, you should not report these codes unless they have been definitively diagnosed by a qualified healthcare provider, such as a pulmonologist.

- Answers for You be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Alan L. Plummer, MD, professor of medicine, division of pulmonary, allergy and critical care at Emory University School of Medicine in Atlanta.