Pain Management Coding Alert

Question: I just started working at a PM clinic that performs sleep studies, and trying to bone up on my ICD-10 skills for sleep-related issues. I happened upon the circadian rhythm sleep disorder entry, and got confused pretty quickly. Could you run down the different types of circadian rhythm sleep disorder?

Michigan Subscriber

Answer: There are six different types of circadian rhythm disorders with specific ICD-10 codes, along with three codes that represent unclassified sleep disorders. Here’s the six-pack of circadian rhythm sleep disorders laid out in ICD-10:

• Delayed sleep phase: According to sleepedu­cation.org, this disorder features “a sleep pattern that is delayed by two or more hours so that a person goes to sleep later at night and sleeps later in the morning.” Code this condition with G47.21 (Circadian rhythm sleep disorder, delayed sleep phase type).
• Advanced sleep phase: “This circadian disorder causes people to fall asleep several hours before a normal bedtime and wake up hours earlier than most people wake in the morning,” sleepeducation.org reports. Code this condition with G47.22 (… advanced sleep phase type). 
• Irregular sleep-wake: Patients who suffer this disorder have circadian rhythms “so disorganized that there is no clear sleep or wake pattern. People with this sleep disorder may sleep off and on in a series of naps over a 24-hour period,” reports sleepeducation.org. Code this condition with G47.23 (… irregular sleep wake type).
• Free running: Also called non-24-hour-sleep-wake rhythm, free running “is a sleep disorder that causes a person’s sleep time to shift a little later every day. Sleep times may go in and out of alignment with other people over time,” according to sleepedu­cation.org. Code this condition with G47.24 (… free running type).
• Jet lag: Patients who travel across multiple time zones and have difficulty adjusting to the new schedule, or their old schedule upon return home, suffer from this type of disorder. Code this condition with G47.25 (… jet lag type).
• Shift work: Patients who work a non-traditional schedule can acquire this disorder. “The condition causes your sleep to be poor and consistent feelings of fatigue or exhaustion,” sleepeducation.org states. Code this condition with G47.26 (… shift work type).

When you code your first circadian sleep disorder claim, check the encounter notes for signs of any of the above specific conditions. The provider might spell out which type of disorder the patient suffers from; failing that, you might be able to ascertain which type of circadian sleep disorder the patient has from context clues in the notes.

1 more thing: You might also need to use these circadian sleep disorder ICD-10 codes in certain situations:

• G47.20 — Circadian rhythm sleep disorder, unspecified type
• G47.27 — Circadian rhythm sleep disorder in conditions classified elsewhere
• G47.29 — Other circadian rhythm sleep disorder.

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