Narcolepsy is a long-term neurological disorder that affects the brain’s ability to control sleep-wake cycles. This chronic sleep disorder causes a person to suddenly fall asleep at inappropriate times. It is characterized by excessive sleepiness, sleep paralysis, overwhelming daytime drowsiness, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter). Narcolepsy that occurs with cataplexy is called Type 1 narcolepsy. Narcolepsy that occurs without cataplexy is known as Type 2 narcolepsy. In most cases, people suffering from narcolepsy find it difficult to stay awake for long periods of time, regardless of the circumstances, which can in turn cause serious disruptions in their daily routine. There is no specific cure for narcolepsy; however, medications and behavioral lifestyle treatments or changes can help manage symptoms effectively. Medical coding for narcolepsy sleep disorder is quite challenging, as there are several rules related to reporting the procedure accurately. Reliable medical billing and coding companies can help physicians report this chronic sleep disorder correctly on their medical claims and obtain optimal reimbursement.

Narcolepsy affects both males and females equally. Reports from WUN (Wake up Narcolepsy – a non-profit organization that seeks to raise awareness about narcolepsy) suggest that narcolepsy affects about 1 in every 2,000 Americans and 3 million people worldwide. The typical onset of this condition is between the ages of 15 and 25, but can also become apparent at early childhood. In many cases, narcolepsy remains undiagnosed and, therefore, untreated. It is estimated that up to 50% of patients with Narcolepsy may be undiagnosed.

Typical Causes and Symptoms of Narcolepsy

The exact cause of narcolepsy is unknown. Researchers suggest that the condition may occur due to a combination of multiple factors that lead to neurological dysfunction and REM sleep disturbances. Nearly all people with narcolepsy who have cataplexy have extremely low levels of the naturally occurring chemical hypocretin, which promotes wakefulness and regulates REM sleep by the brain. Several other factors that cause this chronic sleep condition include – inherited genetic fault, autoimmune disorders, brain injuries and age and family history of the patient.
Even though narcolepsy is a lifelong problem, it does not worsen as the person ages. The symptoms may partially improve over time, but they will never disappear completely. The signs and symptoms may worsen for the first few years and then continue for life. The most typical symptoms are – excessive daytime sleepiness, sudden loss of muscle tone (cataplexy), sleep paralysis, changes in rapid eye movement (REM) sleep, hallucinations, fragmented sleep and insomnia, automatic behaviors, memory problems, headache and depression.

Diagnosing and Treating Chronic Sleep Disorder

Diagnosis of narcolepsy begins with a detailed clinical examination and review of the medical history of patients. Physicians may make a preliminary diagnosis of this condition by recording patient’s level of excessive daytime sleepiness and sudden loss of muscle tone (cataplexy). Patients may be asked to maintain a sleep journal noting the times of sleep and symptoms over a one- to two-week period. Several diagnostics tests like – Polysomnography (PSG) and multiple sleep latency test (MSLT) may be conducted to diagnose narcolepsy and determine its level of severity.
Although there is no cure for this sleep condition, the symptoms (EDS and symptoms of abnormal REM sleep, such as cataplexy) can be controlled in most people with drug treatment. Medications include – Stimulants (like Modafinil (Provigil) or Armodafinil (Nuvigil), Amphetamine-like stimulants, Methylphenidate (Aptensio XR, Concerta, and Ritalin), Sodium oxybate and other antidepressant drugs. Incorporating lifestyle adjustments such avoiding the intake of caffeine, alcohol and nicotine, regulating sleep schedules, establishing a normal exercise pattern and meal schedule and scheduling short naps (10-15 minutes in length) at regular intervals during the day may help reduce symptoms in the long-run.

Allergy and sleep medicine medical coding involves using the specific ICD-10 diagnosis codes, CPT codes and HCPCS codes for reporting narcolepsy on the medical claims providers submit to health insurers for reimbursement.

ICD-10 Codes to Use for “Narcolepsy”

G47.4 – Narcolepsy and cataplexy
G47.41 – Narcolepsy

  • G47.411 – Narcolepsy and cataplexy, with cataplexy
  • G47.419 – Narcolepsy and cataplexy, without cataplexy

G47.42 – Narcolepsy in conditions classified elsewhere

  • G47.421 – Narcolepsy in conditions classified elsewhere, with cataplexy
  • G47.429 – Narcolepsy in conditions classified elsewhere, without cataplexy

CPT Codes for Narcolepsy Diagnostic Testing

  • 95782 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
  • 95783 – Polysomnography; younger than 6 years, sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist
  • 95800 – Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time
  • 95801 – Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (e.g., by airflow or peripheral arterial tone)
  • 95803 – Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording)
  • 95805- Multiple Sleep Latency or Maintenance Of Wakefulness Testing, recording, analysis and interpretation of physiological measurements of sleep during multiple trials to assess sleepiness
  • 95806 – Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g., thoraco abdominal movement)
  • 95807 – Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist
  • 95808 – Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist
  • 95810 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
  • 95811 – Polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of Continuous Positive Airway Pressure therapy or bi-level ventilation, attended by a technologist

HCPCS Codes

  • G0398 – Home Sleep Study Test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
  • G0399 – Home Sleep Test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
  • G0400 – Home Sleep Test (HST) with type IV portable monitor, unattended; minimum of 3 channels

Dealing with narcolepsy can be challenging. Making necessary adjustments in your daily schedule may help. Taking adequate safety precautions, (particularly when driving) is important for people with narcolepsy. People with untreated symptoms are more likely to be involved in severe automobile accidents. However, these risks may be comparatively lower among individuals who regularly consume medications. Falling asleep suddenly or losing muscle control during normal activities can transform even safe actions into hazards. For workers, it is important to communicate with employers about their sleep disorder and work with them to find ways to accommodate their needs. The Americans with Disabilities Act (ADA) requires employers to provide reasonable accommodations for all employees with disabilities. Adults with narcolepsy can negotiate with employers to modify their work schedules in such a way that they can take naps in between (when essential) and perform the most demanding tasks when they are most alert.

Medical coding for narcolepsy sleep disorder can be complex. With all the challenges involved, the best option for sleep medicine physicians is to rely on specialized medical billing and coding services for timely and accurate claim submission. Expert teams in an established outsourcing company can handle all the billing and coding challenges competently and help healthcare providers maximize revenue cycle and improve patient care.