Pulmonology Coding Alert

Question: A patient’s general practitioner referred them to our pulmonology practice after they discussed the patient’s poor sleep quality at the annual wellness visit. The pulmonologist ordered a sleep study and reported the findings. The documentation mentions the patient snores loudly, experiences frequent disruptions in breathing, and was restless during the night. After the study, the physician diagnosed the patient with obstructive sleep apnea.

Should I use G47.30 or G47.39 to document the patient’s condition?

North Dakota Subscriber

Answer: The sleep apnea diagnosis codes are listed under parent code G47.3 (Sleep apnea), which carries an icon that indicates correct reporting requires a 5th character. You’ll use code G47.30 (Sleep apnea, unspecified) for a nonspecific case of sleep apnea, but you’ll use code G47.39 (Other sleep apnea) for other types of sleep apnea that can’t be specified by another diagnosis code.

But you won’t use either of those codes for the diagnosis, as G47.33 (Obstructive sleep apnea (adult) (pediatric)) is the code that applies to the physician’s obstructive sleep apnea diagnosis. This code features the additional synonym, Obstructive sleep apnea hypopnea, that a provider may also use in their documentation.

Remember: When you use G47.3, you will need to bear in mind the following ICD-10-CM instructions:

Code Also note: Parent code G47.3 features an instruction for you to also code “any associated underlying condition” that will fully describe the patient’s condition.

Excludes1 note: Parent code G47.3 features an Excludes1 note that indicates R06.81 (Apnea, not elsewhere classified), R06.3 (Cheyne-Stokes breathing), E66.2 (Pickwickian syndrome), and P28.3 (Primary sleep apnea of newborn) cannot be reported with codes in the G47.3 code family.

Excludes2 note: Parent code G47 (Sleep disorders) features an Excludes2 note that allows you to report F51.5 (Nightmare disorder), F51.- (Sleep disorders not due to a substance or known physiological condition), F51.4 (Sleep terrors [night terrors]), and F51.3 (Sleepwalking [somnambulism]) with G47.33 if the patient experiences multiple conditions at the same time.