Neurology & Pain Management Coding Alert

Tip: Don’t forget to include other associated sleep conditions on your claim.

Some coders and clinicians dread the switch to ICD-10 because they believe the vast number of diagnosis choices will be confusing and make filing claims more difficult. As a neurology coder, however, you’ll be glad to learn that diagnosis coding for sleep apnea actually will be simpler with ICD-10 because of the range of choices. 

Compare ICD-9 Options to ICD-10

Today, when your clinician diagnoses sleep apnea but does not specify the cause for the apnea, you select 780.57 (Unspecified sleep apnea). When your physician documents sleep apnea with insomnia, you report it with ICD-9 code 780.51 (Insomnia with sleep apnea, unspecified). If your physician documents sleep apnea with hypersomnia, you report diagnosis 780.53 (Hypersomnia with sleep apnea, unspecified).

Be careful: You cannot choose from the 780.5x series of ICD-9 codes if your clinician identifies the condition as: 

• Circadian rhythm sleep disorder (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)
• Parasomnias (327.40-327.49) 
• Sleep disorders of nonorganic origin (307.40-307.49)
• Obstructive sleep apnea (327.23, Obstructive sleep apnea [adult] [pediatric]). 

ICD-10 change: When ICD-10 becomes effective in October 2015, you’ll choose from the code family of G47- (Sleep disorders) when reporting any sleep disorders. 

Difference: But unlike in ICD-9, you will not have different ICD-10 codes when your clinician identifies apnea with insomnia, hyposomnia, or hypersomnia. When your clinician identifies apnea but does not identify the cause for the apnea, you’ll code the condition with G47.30 (Sleep apnea, unspecified). If your clinician also identifies other sleep disturbances such as insomnia or hypersomnia, you’ll have to report it separately with other ICD-10 codes. You’ll report insomnia with G47.0- (Insomnia) and hypersomnia with G47.1- (Hypersomnia).

Reminder: You should not use G47.30 when your clinician identifies the condition as apnea not elsewhere classified (R06.81); Cheyne-Stokes breathing (R06.3); pickwickian syndrome (E66.2); or sleep apnea of newborn (P28.3). If your provider diagnoses obstructive sleep apnea (OSA), you report the condition with G47.33 (Obstructive sleep apnea [adult] [pediatric]).

Verify Supporting Documentation 

Your provider will arrive at a diagnosis of sleep apnea based on a complete history and examination of the patient. Some of the complaints that your neurologist would most likely record in a patient with sleep apnea include breathlessness during sleep, loud snoring, difficulty maintaining sleep, and waking up with a very dry or sore throat. The patients also experience morning headache, daytime sleepiness, trouble with concentration, slower reaction time, and reduced productivity at work.

When the neurologist suspects sleep apnea, he will assess the patient for obstructive sleep apnea. He will check for obesity, craniofacial problems such as retrognathia (reduced size of the lower jaw), cleft palate, or changes to the dimension of the tongue and other soft tissues of the orophargyngeal region. He will also perform a nasal examination to check for any signs of obstruction.

Tests: 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. 

Apart from these blood tests, your clinician might also check for pulmonary problems that might be contributing to the apnea. These can include oximetry, pulmonary function tests such as spirometry, diffusing lung capacity, and lung volume. 

Once the physician has these test results, he might opt to complete sleep studies and polysomnography to determine the patient’s sleep patterns and wakefulness.

Example: A 62-year-old male patient reports to your neurologist with complaints of restlessness during sleep, frequent arousal from sleep due to a gasping or choking sensation, and recent episodes of daytime sleepiness. He says these incidents are affecting his day-to-day schedules, and he has difficulties with concentration.

Your physician performs a comprehensive evaluation of the patient and suspects sleep apnea. He examines the patient’s oropharyngeal areas and the nasal passages but finds no signs of obstruction. Your physician notes that the patient is not obese.

He withdraws a blood sample and sends it to the lab for hematocrit and hemoglobin values. He also draws an arterial blood sample that he sends for analysis of blood gases. Imaging studies of the respiratory system do not show any abnormalities.

He decides to order a polysomnography (PSG) that records EEG, EOG, EMG, ECG, airflow, and oxygen saturation followed by maintenance of wakefulness (MOW) test the next day. Based on signs and symptoms and results of lab tests and the PSG and MOW, your clinician arrives at the diagnosis of sleep apnea.

What to report: You report the encounter with the patient using an appropriate E/M code. You report the diagnosis with 780.57 if you are using ICD-9 codes or report G47.30 with ICD-10 codes.