Otolaryngology Coding Alert

When your physician reports "organic sleep apnea," it means he identified a specific cause of the sleep apnea. For example, when the ENT determines that excessive weight pressing on the patient's ribs and lungs is causing the sleep apnea, you would report 327.23 (Obstructive sleep apnea [adult] [pediatric]).

Sleep apnea can be caused by either complete obstruction of the airway (obstructive apnea) or partial obstruction (obstructive hypopnea -- slow, shallow breathing), both of which can wake one up. There are three types of sleep apnea -- obstructive, central, and mixed. Of these, obstructive sleep apnea (OSA) is the most common.

Until a few years ago, the only relevant codes for obstructive sleep apnea were 780.51 (Insomnia with sleep apnea), 780.53 (Hypersomnia with sleep apnea), and 780.57 (Other and unspecified sleep apnea). Many ENTs "would simply use 780.57 automatically, so as not to have to distinguish hypersomnia, insomnia, or other symptoms associated with obstructive sleep apnea," says Ed Weaver, MD, associate professor and chief of sleep surgery at the University of Washington's Department of Otolaryngology -- Head and Neck Surgery.

But ICD-9 revised the codes and added several new ones for sleep disorders, including organic sleep apnea, 327.2x. So what's the difference? You would report unspecified sleep apnea (780.57) if your ENT is unable to identify the cause of the apnea or if he is still trying to determine the cause. All the 780.5x codes are "unspecified," meaning that you should use them only when your physician doesn't give a specific cause for the condition. All the 327.2x codes, except 327.20 (Organic sleep apnea, unspecified), are "specified" causes of organic sleep apnea. Your ENT would have to provide more information about the cause for you to use one of the more specific codes. "Organic sleep apnea (327.2x) is diagnosed when the sleep apnea is confirmed on sleep testing," Weaver says. "The other sleep apnea codes (780.5x) are under the category 'Symptoms, Signs, and Ill-Defined Conditions,' and are really codes to specify symptoms."