Pulmonology Coding Alert

Question: A new patient reports to the pulmonologist. He says that shortly after waking up in the morning, it is extremely difficult for him to move his arms and legs. The patient says this has been happening "off and on" for about three weeks. He also reports mild hallucinations during these times of "paralysis." The pulmonologist diagnoses sleep paralysis during a level-four E/M. I have pored over the sleep disorder ICD-9 code set (327.xx) and cannot find a diagnosis. Should I code the patient's symptoms?

North Carolina Subscriber

Answer: There is an ICD-9 code for sleep paralysis. The proper code for this patient's condition is 327.43 (Recurrent isolated sleep paralysis).

On the claim, append 327.43 to 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a comprehensive history; a comprehensive examination; medical decision-making of moderate complexity).

-- Answers to You Be the Coder and Reader Questions were answered/ reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.