Neurology & Pain Management Coding Alert

Acceptable diagnoses for sleep studies and polysomnography (95805-95811 and 54250) differ from payer to payer, although Medicare guidelines set the standard. Below is a partial list of acceptable diagnoses derived from the local medical review policies of several Medicare carriers throughout the nation. Contact your individual payers for a complete list of applicable ICD-9 codes (Note: Code 95806 [unattended study] is not covered).

 For 54250:
  302.72 Psychosexual dysfunction; with inhibited exual excitement
  607.84 Other specified disorders of penis; impotence of organic origin.

 For 95805:
  347 Cataplexy and narcolepsy
  780.53 Hypersomnia with sleep apnea
  780.54 Other hypersomnia.

 For 95807-95811:
  278.01 Morbid obesity with sleep apnea
  278.8 Pickwickian syndrome
  333.2 Myoclonus
  345.8x Nocturnal seizures
  347 Cataplexy and narcolepsy
  518.81 Acute respiratory failure
  780.09 Alteration of consciousness; drowsiness, somnolence
  780.51 Insomnia with sleep apnea
  780.53 Hypersomnia with sleep apnea
  780.54 Other hypersomnia
  780.55 Disruptions of 24-hour sleep-wake cycle
  780.56 Dysfunctions associated with sleep stages or arousal from sleep
  780.57 Other and unspecified sleep apnea
  780.59 Other sleep disturbances.