Neurology & Pain Management Coding Alert

Heads up: You'll need multiple codes to help specify the type of apnea.

Coding for sleep apnea will include a nice surprise when ICD-10 goes into effect later this year – your diagnoses will actually be easier in some ways than they are now with ICD-9 because most codes will be in the same category.

ICD-9 choices: When your neurologist diagnoses sleep apnea but does not specify the cause for the apnea, you currently choose 780.57 (Unspecified sleep apnea). When your provider documents sleep apnea with either insomnia or hyposomnia, you submit 780.51 (Insomnia with sleep apnea, unspecified). Your third option is for cases when your physician documents sleep apnea with hypersomnia; you report ICD-9 code 780.53 (Hypersomnia with sleep apnea, unspecified).

Caution: You should not use the 780.5x series of ICD-9 codes if your clinician identifies the condition as circadian rhythm sleep disorders (327.30-327.39); organic hypersomnia (327.10-327.19); organic insomnia (327.00-327.09); organic sleep apnea (327.20-327.29); organic sleep related movement disorders (327.51-327.59); organic parasomnias (327.40-327.49), or of nonorganic origin (307.40-307.49). Or, if your neurologist identifies the condition as obstructive sleep apnea, then you report it with 327.23 (Obstructive sleep apnea [adult] [pediatric]).

ICD-10 change: You'll turn to the G47- (Sleep disorders) code group when reporting any sleep disorders with ICD-10. But, you'll no longer have different ICD-10 codes for coding apnea with insomnia, hyposomnia, or hypersomnia. When your clinician diagnoses apnea but does not identify the cause for the apnea, you'll report the condition with G47.30 (Sleep apnea, unspecified). If your clinician also identifies other sleep disturbances such as insomnia or hypersomnia, you'll report it separately with other ICD-10 codes. For example, you'll code insomnia with G47.0- (Insomnia) and hypersomnia with G47.1- (Hypersomnia).

Reminder: ICD-10 guidelines specify several conditions you cannot code with G47.30. These include apnea not elsewhere classified (R06.81); Cheyne-Stokes breathing (R06.3); pickwickian syndrome (E66.2); or sleep apnea of newborn (P28.3). Also note that if your neurologist diagnoses obstructive sleep apnea (OSA), you will code with G47.33 (Obstructive sleep apnea [adult] [pediatric]).

Documentation: Your provider will arrive at a diagnosis of sleep apnea based on a complete history and evaluation of the patient. Some of the complaints that your clinician would most likely record in a patient with sleep apnea will include breathlessness during sleep, snoring, and difficulty in falling asleep and maintenance of sleep. The patient will also likely complain of daytime sleepiness and reduced productivity at work. Other findings the neurologist might document include drowsiness, reduced ability to concentrate, slower reflexes, hypertension, and poor appetite.

Tests: When your clinician is assessing a patient for sleep apnea, some of the lab tests that he is most likely to order include blood tests such as hematocrit and hemoglobin counts, thyroid function tests, and tests for arterial blood gases (ABG). The ABG tests will help in determining the level of oxygen saturation and level of carbon dioxide in the blood.

The physician might also opt for oximetry, pulmonary function tests such as spirometry, diffusing lung capacity, and lung volume to check for any pulmonary problems that might be contributing to the apnea. He might also order sleep studies or polysomnography to determine the patient's sleep patterns and wakefulness.

Documentation of all these tests and observations help support the final diagnosis of sleep apnea. Remind your physicians that the more thoroughly they document these details, the more accurately you can code the patient's diagnosis and treatment.