Pulmonology Coding Alert

Question: The pulmonologist performs a level-three E/M on a patient with sleep issues. The medical record indicates that the patient had obstructive sleep apnea caused by excess weight. Should I use ICD-9 code 780.51 to represent this condition?

Nevada Subscriber

Answer: No. ICD-9 780.51 (Insomnia with sleep apnea, unspecified) is not specific enough for your scenario. You would use this code when the physician cannot (or has not yet) determined the cause of the condition.

If the physician confirms that the patient has OSA, you should instead choose 327.23 (Obstructive sleep apnea [adult] [pediatric]) as a diagnosis.

On the claim, link 327.23 to 99213 (Established patient visit for the evaluation and management of a patient, which requires these three key components: an expanded problem focused history; an expanded problemfocused examination; medical decision-making of low complexity). Also, include 278.01 (Morbid obesity) as a secondary diagnosis to represent the patient's co-morbidity.