Primary Care Coding Alert

Avoid unspecified insomnia, apnea codes with new 327 series

Although this fall's proposed creation of 21 sleep-problem-related diagnoses allows for more specificity, the new codes' lack of straightforward terms, such as central sleep apnea, may leave you rubbing your eyes.

Family physicians have long struggled with correlating the medical sleep disorder diagnoses with ICD-9 terminology. When the new ICD-9 codes become effective Oct. 1, 2005, here's what you can expect.

Note: This article is the final installment of the three-part series discussing this fall's ICD-9 changes. For information on codes for personal history and vaccination not carried out, see the September 2005 Family Practice Coding Alert. The August issue details the body mass index additions and dehydration changes.

780 Series Offers More Unspecified Codes

A lot 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 will move five 780.xx codes into this designation.

The nitty-gritty: Two codes (780.52 and 780.54) will go from "other specified" codes to "unspecified" codes. Code 780.57 will become entirely unspecified. Two codes (780.51 and 780.53) that now have specific descriptors, such as "hypersomnia with sleep apnea," will change to unspecified codes. On Oct. 1, 780.53 will read "hypersomnia with sleep apnea, unspecified." (See full descriptors in "Replace Your OHS, Apnea and Hypersomnia Diagnoses With These New Codes" later in this issue.)

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 types and causes of insomnia, hypersomnia, sleep apnea and other breathing issues. "Family physicians will benefit from having different types for these conditions," says Daniel S. Fick, MD, director of risk management and compliance at the University of Iowa in Iowa City.

Example: The new edition of ICD-9 will allow 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'll also be able to 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)," Fick says.

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 holding your breath that the new code series (327.xx) will make coding correlate with medical sleep disorder diagnoses, the new ICD-9 isn't the answer to your prayers.

"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 actually 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) (pediatric)" (new code 327.23).

The commonly diagnosed "central sleep apnea" (780.51, Insomnia with sleep apnea) becomes 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" (now classified as 780.51), the new ICD-9 will offer "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.