Neurology & Pain Management Coding Alert

ICD-9 brings you detailed codes to describe insomnia, apnea and more

If you've had trouble matching your doctors' descriptions of sleep disorders with diagnosis codes from ICD-9, you can choose from 21 new and five revised sleep disturbance diagnoses, beginning Oct. 1.

The new and revised codes approximate more closely clinical descriptions of sleep disturbances as documented by neurologists and other physicians.

New Series Offers More Detail

If you're searching for a specific sleep disorder diagnosis, you should try looking to 327.01-327.29. The new series - located in the "Nervous System and Sense Organs" Chapter of ICD-9 - goes into much more detail about types and causes of insomnia, hypersomnia, sleep apnea and other breathing issues.

"I'm glad to have new codes because they will offer more specificity," says LeeAnn Greenough, CPC, a certified coder in Roswell, Ga.
 
Example: The new ICD-9 will allow you to specify whether a patient with idiopathic hypersomnia (now coded as 780.54, Other hypersomnia) has long sleep (327.11, Idiopathic hypersomnia with long sleep time) or doesn't (327.12, ... without long sleep time).

You'll also be able to use the new sleep disturbance codes for patients who have sleeping problems because of other reasons.

"If a patient can't sleep due to anxiety or depression, you can use 327.01 (Insomnia due to medical condition classified elsewhere) or 327.02 (Insomnia due to mental disorder)," says Daniel S. Fick, MD, director of risk management and compliance at the University of Iowa in Iowa City. You should code the mental disorder (for example, 296.3x, Major depressive disorder, recurrent episode) as the primary diagnosis.

Apnea Becomes Easier to Diagnose

You no longer have to search in vain for a diagnosis code to describe central sleep apnea. For 2006, ICD-9 will include 327.27 (Central sleep apnea in conditions classified elsewhere).

Previously, there was no code to describe this condition, says Marc Raphaelson, MD, a neurologist in Frederick, Md., and a member of the American Academy of Neurology's medical economics and management committee.

"The new diagnoses make life easier in several ways," Raphaelson continues. For instance, you can now report obstructive sleep apnea using a single code - 327.23 (Obstructive sleep apnea [adult] [pediatric]) - rather than having to choose among three similar codes, as in the past.

Raphaelson explains that formatting for the new ICD-9 codes has been a joint effort to reduce confusion when reporting sleep disorders:

"When the first International Classification of Sleep Disorders [ICSD] was produced, in about 1990, there was no correlation with ICD-9. Still worse, the ICSD codes were given numbers and formatting similar to ICD-9 codes, so physicians and insurers were confused. For ICSD-2, a coordination committee worked from the start to be sure that each ICSD-2 diagnosis is represented more properly by a diagnosis in ICD-9."

5 Revised Codes Become Unspecified

You should generally avoid "unspecified" diagnoses. Nevertheless, the inclusion of several more-specific codes in ICD-9 to describe sleep apnea, insomnia and hypersomnia has lead to the revision of five codes formerly used to describe these conditions: