Billing and Coding for Parasomnia – A Primary Sleep Disorder

by | Published on Jul 22, 2020 | Medical Coding

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Sleep disorders can directly affect a person’s overall health and quality of life. Good sleep is essential to maintain optimal health, and sleep disorders can significantly affect hormone levels, mood, body weight and increase your risk of other health problems. Common signs and symptoms associated with these sleep disorders include – excessive daytime sleepiness, irregular breathing or increased movement during sleep. There are different types of sleep disorders – each is grouped under specific categories that explain or give reasons on why these conditions occur or how they affect an individual’s quality of life. Parasomnia is one such unique sleep disorder that causes abnormal behavior while sleeping. This is a broad term used to describe disruptive behavioral or physiological events occurring in association with sleep, specific-sleep stages or sleep-wake transitions. Often referred to as “Bumps in the Night” in the sleep medicine field, this may include abnormal movements, behavior, emotions or dreams. Although these behaviors may appear complex and purposeful to others, patients may remain asleep during the event and in most cases do not have complete memory of what events occurred during the night. If left untreated, parasomnias can be disruptive to both the patient and the bed partner and can lead to severe psychological stress. Sleep medicine specialists who treat patients need to correctly diagnose the symptoms, causes and understand the various types of parasomnias. To code the diagnosis and treatments correctly, they can rely on reputable medical coding companies.

Causes and Types of Parasomnias

There are several causes of parasomnias, each associated with multiple triggers like – stress, anxiety, substance use, depression, irregular sleep schedules/disorders, use of certain medications, sleep deprivation and certain neurological conditions like Parkinson’s disease.

There are different types of parasomnias. Some can occur during the first half of the night, from non-rapid eye movement sleep, while other types can occur during arousals from REM (rapid eye movement) sleep, later in the night. Primary parasomnias are disorders of sleep states, while secondary parasomnias are disorders of other organ systems that arise during sleep.

Non-REM Parasomnias

  • Sleep terrors/night terrors – Regarded as a disorder of arousal, the patient with this sleep disorder awakes from sleep in a frightened state often accompanied by crying or screaming, with an increase in heart rate or sweating. The person may be awake during this stage but may be unable to communicate properly.
  • Sleepwalking – Often called somnambulism, this type of parasomnia occurs when a person appears to be awake and moving around with eyes wide open, but is actually asleep.
  • Confusional arousals – This can occur when a person gets awakened from deep sleep during the first part of the night and remains in a confused manner.

REM Parasomnias

  • Sleep paralysis – In this type of sleep disorder, a patient may not be able to move the body when falling asleep or waking up due to their muscles being paralyzed, even when they are awake.
  • REM sleep behavior disorder (RBD) – People with this sleep condition act out unpleasant dreams during REM sleep. They may display forceful arm and leg movements and also make sounds.
  • Nightmares – People see vivid dreams during sleep that can cause feelings of fear, terror, and/or anxiety.


Apart from the unusual behavior during sleep time, parasomnia involves other symptoms like –

  • Excessive daytime sleepiness or fatigue
  • Find unfamiliar cuts on your body
  • Have difficulty sleeping throughout the night
  • Not remember doing certain activities
  • Wake up confused or disoriented

How to Diagnose and Treat Parasomnia

Diagnosis of parasomnia sleep disorder is done by a sleep medicine specialist. A sleep specialist will analyze the patient’s sleeping pattern and behavior. As part of the diagnosis, these specialists may at times ask patients to maintain a sleep journal where they can note down the details of their sleep patterns like what time they went to sleep and the time they wake up from their sleep. Physicians will also ask details about underlying medical conditions, current medications, family history, and lifestyle behavior. In some cases, a polysomnogram may be performed wherein a patient may sleep in a lab overnight and the sleep specialist may analyze the sleeping behavior. Physicians may record the brain waves, breathing, and heart rate to make a diagnosis.

Treatment for this condition, in most cases depends on the type and severity of the parasomnia. Common treatment options include – medications and cognitive behavioral therapy (CBT). In addition, physicians may also suggest some home treatments like – scheduled awakenings (awakening a patient 15 to 30 minutes before they spontaneously wake up) and arranging a safe sleep environment for patients. All diagnoses, screening and treatment procedures must be carefully documented using the correct medical codes. Billing and coding services offered by experienced medical billing and coding companies can ensure the correct codes on the medical claims. ICD-10 diagnosis codes for different types of Parasomnia include –

  • G47.5 Parasomnia
  • G47.50 Parasomnia, unspecified
  • G47.51 Confusional arousals
  • G47.52 REM sleep behavior disorder
  • G47.53 Recurrent isolated sleep paralysis
  • G47.54 Parasomnia, in conditions classified elsewhere
  • G47.59 Other parasomnia

Parasomnia is a complex sleep disorder that can affect the quality of sleep and increase the risk of accidents and health problems due to lack of rest. Patients need to immediately contact a sleep specialist if they notice any abnormal sleep-related behaviors (especially those associated with injuries or sleep disruption). They should make it a habit to maintain a normal sleep schedule to get enough sleep.

Allergy and sleep medicine medical billing and coding can be challenging. Physicians can consider hiring medical coding services as this would ensure accurate reporting of diagnostic details and help avoid delayed / denied claims.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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