Otolaryngology Coding Alert

The 327 series offers an alternative to unspecified insomnia, apnea diagnoses

The new ICD-9 sleep-problem codes that took effect on Oct. 1 allow for more specificity. The trouble is, the new codes lack straightforward terminology, and several additional unspecified codes may cause you to lose sleep.

780 Series Offers More Unspecified Codes

Many of the new ICD-9 codes describe sleep and breathing disorders. The update revises sleep disturbances codes 780.51-780.57 to clarify that they cover only -unspecified- cases.

Most coders know to avoid unspecified codes like the plague. The new ICD-9 edition moves five 780.xx codes into this designation.

The nitty-gritty: Two codes (780.52 and 780.54) went from -other specified- codes to -unspecified- codes. Code 780.57 became entirely unspecified. Two codes (780.51 and 780.53) that had specific descriptors, such as -hypersomnia with sleep apnea,- are now unspecified codes. On Oct. 1, 780.53 became -hypersomnia with sleep apnea, unspecified.-

Go Into Specifics With New 327 Category

For specific diagnoses, you-ll look to 327.01-327.29. The new series--located in the Nervous System and Sense Organs chapter--goes into much more detail about the types and causes of insomnia, hypersomnia, sleep apnea and other breathing issues

Example: The new edition of ICD-9 allows 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 not (327.12, Idiopathic hypersomnia without long sleep time).

You can also use the new sleep disturbance codes for patients who have sleeping problems due to 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 director of risk management and compliance at the University of Iowa in Iowa City.

Important: Make sure you first code the medical condition or mental disorder. For instance, if a patient can't sleep due to anxiety depression, you should report 300.4 (Dysthymic disorder) and then 327.02.

327.xx Doesn't Align ICD-9 With AASM

If you-re hoping that the new code series (327.xx) will make coding correlate with medical sleep disorder diagnoses, the new ICD-9 isn't the answer you-re looking for.

-I find it interesting that these codes are coming out when the American Association of Sleep Medicine (AASM) has their new book (International Classification of Sleep Disorders) at press or released,- says Jill Young, CPC, an AAPC National Advisory Board member and president of Young Medical Consulting in East Lansing, Mich.
 
Sleep disorder specialists have been working with National Center for Health Statistics staff (cosponsors of the ICD-9-CM Coordination and Maintenance Committee) to bring the ICD up-to-date with the current classification of sleep disorders.

Problem: The new ICD-9 codes may be overly detailed. Rather than offering a straightforward -obstructive sleep apnea- diagnosis (now lumped under 780.53, Hypersomnia with sleep apnea), you will have to choose "obstructive sleep apnea (adult)(pediactric)," new code 327.23

The commonly diagnosed -central sleep apnea- (780.51, Insomnia with sleep apnea) became either -primary central sleep apnea- (327.21)--as the main problem--or -central sleep apnea in conditions classified elsewhere- (327.27).

For -obesity hypoventilation syndrome- (which was classified as 780.51), the new ICD-9 offers -sleep-related hypoventilation/hypoxemia in conditions classifiable elsewhere- (327.26).

In fact, the 327.xx series confounded Young's physicians. When she asked one of her doctors about the new codes, -He looked perplexed and said he would wait and see what the new sleep book holds,- Young says.