Neurology & Pain Management Coding Alert

Question: Our physician diagnosed a seven-year-old child with obstructive sleep apnea with adenotonsillar hyperplasia. Should we code 327.23 or 780.57 for the sleep apnea? 

New Mexico  Subscriber 

Answer: Because the neurologist specified obstructive sleep apnea, report 327.23 (Obstructive sleep apnea [adult] [pediatric]). Diagnosis 780.57 (Unspecified sleep apnea) represents cases without obstruction or without enough details in the documentation to report 327.23. Notice that the ICD-9 code 327.73 includes adults and children in the descriptor. The parenthesis are used to indicate supplementary words that may be present or absent without affecting the diagnosis code, so 327.23 is the correct choice for obstructive sleep apnea at any age.

Looking ahead: When you begin coding based on ICD-10, 327.23 will become G47.33 (Obstructive sleep apnea [adult] [pediatric]). Diagnosis 780.57 will be replaced by G47.30 (Sleep apnea, unspecified). The transition should be easy since you’ll be working with new codes but the same descriptors you currently report. ICD-10 also relocates the “sleep disturbances” diagnoses such as insomnia, hypersomnia, etc., from the Signs and Symptoms chapter to the Nervous System chapter. As such, the diagnoses will both be in the G47 category for sleep disorders instead of being in separate areas as they are in ICD-9.