Pulmonology Coding Alert

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

Minnesota Subscriber

Answer: ICD-9 code 780.51 (Insomnia with sleep apnea, unspecified) is not specific enough for your scenario. Use 780.51 when the physician cannot (or has not yet) determined the cause of the condition.

Because the pulmonologist noted that excess weight caused the apnea, you should choose 327.23 (Obstructive sleep apnea [adult] [pediatric]) as a diagnosis.

On the claim, report 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a detailed history; a detailed examination; medical decision-making of low complexity) and 327.23. Also, include 278.01 (Morbid obesity) as a secondary diagnosis to represent the cause of the patient's obstructive sleep apnea.