Otolaryngology Coding Alert

Polysomnography is one way an ENT may use to confirm OSA.

In obstructive sleep apnea (OSA), pauses in breathing (greater than 10 seconds at a time) occur because the airway has become narrowed, blocked, or floppy. One symptom of OSA is snoring. To diagnose OSA, an otolaryngologist will provide a thorough examination of the nose, mouth, throat, palate, and neck, often using a fiberoptic scope. You would report 327.23 for patients suffering from OSA.

ICD difference: When using the ICD-9-CM code set, you report 327.23 (Obstructive sleep apnea [adult] [pediatric]) if the patient gets diagnosed with obstructive sleep apnea. Effective October 2013, ICD-9 327.23 becomes G47.33 (Obstructive sleep apnea [adult] [pediatric]) in ICD-10. The conversion to ICD-10 will offer no difference. In fact, G47.33's descriptor is a carbon copy depiction of ICD-9's 327.23.

Documentation: When diagnosing a sleep disorder such as OSA, a physician may have the patient complete a questionnaire to obtain information on wake-sleep patterns. She may also order blood tests to rule out other conditions. If the physician suspects a sleep disorder, the patient would most likely undergo a polysomnography to record breathing and brain and muscle during sleep. Treatment will depend on the specific type of disorder, and if there is an underlying cause.

Coder tips: One of the ways an otolaryngologist can alleviate this potentially life-threatening condition is with genioglossus advancement. This procedure involves the surgeon creating a small bone window in the front of the lower jaw, and then pulls the tendons that attach the front of the tongue to the jaw forward onto a bone fragment. This creates a larger airway between the back of the tongue and the throat, and results in easier breathing for OSA patients.

You would report mandibular segmental osteotomy with genioglossus advancement with 21199 (Osteotomy, mandible, segmental; with genioglossus advancement) when performed to treat obstructive sleep apnea (OSA).