Pulmonology Coding Alert

The 2006 codes allow you to justify sleep studies for your obese patients
 
Have you been waiting for a better way to describe the causes for your patients' sleep disorders? Help is finally on the way with several new insomnia, hypersomnia and sleep apnea-related diagnosis codes that take effect on Oct. 1.

Bone Up on BMI and Apnea Specificity

Six new sleep apnea codes will debut in October, including a new diagnosis code for unspecified organic sleep apnea (327.20), primary central sleep apnea (327.21), high-altitude periodic breathing (327.22), obstructive sleep apnea for both adult and pediatric patients (327.23), central sleep apnea in conditions classified elsewhere (327.27), and other organic sleep apnea (327.29).

In addition to the six sleep codes, the new codes include an additional 18 new body mass index (BMI) diagnosis codes that range from less than 19 BMI to more than 40 (V85.0-V85.4).

"It's great to see we have gone from 11 payable diagnosis codes to so many," says Karen Dorval, CPC, billing and coding specialist with the Pneumos Clinic in Bismarck, N.D.

Because obesity can aggravate sleep apnea, Dorval says, pulmonology practices will benefit from the new codes that describe people with a higher BMI that may contribute to their sleep apnea diagnosis. "It's about time we have more codes to bill with. Patient treatment is so important, and without the right tools we cannot do our patients justice," Dorval says.

Example: A 55-year-old morbidly obese male (BMI 36.5) with obstructive sleep apnea comes to your practice because he can't sleep at night. The pulmonologist diagnoses him with sleep apnea with insomnia.

Old way: With the current ICD-9 codes, you would not report the patient's BMI as a diagnosis code, coding experts say.

New way: Starting in October, you should report 780.51 for the sleep apnea with insomnia diagnosis in addition to V85.36 (Body mass index 36.0-36.9, adult) because the patient's BMI is 36.5.

Another example: A primary-care physician refers a 65-year-old patient to your pulmonologist for evaluation of central sleep apnea. Your pulmonologist confirms that the patient has the condition.

Old way: Using the current diagnosis codes, there is no diagnosis category for central sleep apnea. In the instance above, you would have reported 780.57 (Other and unspecified sleep apnea), coding experts say.
 
New way: As of Oct. 1, you can report 327.21 (Primary central sleep apnea) to specify primary central sleep apnea because it defines the sleep apnea as primary, which is a more accurate diagnosis than 780.57.

New Classification Debuts for Hypersomnia

In addition to the new codes mentioned above, the new ICD-9 will feature seven codes for hypersomnia, which range from unspecified organic hypersomnia (327.10) to other organic hypersomnia (327.19).

Because ICD-9 previously included only two billable diagnosis codes for hypersomnia, this is a step in the right direction, says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, coding consultant with the Health Texas Provider Network in Dallas.

Example: An internist sends a 58-year-old patient to your practice for evaluation of hypersomnia symptoms. After your pulmonologist observes the patient and discusses the patient's history, he concludes that the patient has hypersomnia stemming from his long battle with severe depression.

Old way: Without the new codes, you would report the patient's diagnosis with 780.54 (Other hypersomnia) and 311 (Depression), Scott says.

New way: Effective Oct. 1, you will have license to code to a much higher level of specificity with the patient. In this instance, you'll report 327.15 (Hypersomnia due to mental disorder) and 311 because the pulmonologist documents that the depression caused the patient's hypersomnia, Scott says.

The new codes allow practices to paint a much clearer picture of the patient and what his needs might be based on specific characteristics that can even cause sleep disorders, such as obesity or depression, Scott says.