Sleep is an important part of one’s daily routine and getting sufficient, quality sleep is vital for physical and mental health. Good quality sleep is essential to maintain critical body functions, restore energy and allow the brain to process new information. Sleep deprivation can cause a range of mental and physical problems. Chronic sleep deprivation can increase the risk of serious health conditions such as diabetes, cardiovascular disease, obesity, and depression. In addition, it can also affect the immune system, reducing the body’s ability to fight off infections and other diseases. Sleep disorders are a group of conditions that affect the ability to sleep on a regular basis. Caused by physical or psychological factors, these disorders can prevent a person from getting restful sleep and, as a result, cause daytime sleepiness and dysfunction. The initial step toward a better night’s sleep is a comprehensive evaluation by a sleep disorder specialist. Treatment modalities for these disorders include – antidepressants, stimulants, antiviral or antifungal medications, lifestyle changes and cognitive-behavioral therapy and exercise therapy. Billing and coding for sleep disorders is a challenging task. Outsourcing these tasks to a reliable medical billing and coding company can help providers stay current on changing codes and billing rules, and ensure proper payment for the services rendered.
Reports suggest that nearly 75 percent of adult Americans experience sleep disorder symptoms at least a few nights per week. It is estimated that about 25 to 30 percent of infants and children also experience some form of sleep disturbances. Sleep disorders can affect the quality and quantity of sleep or cause difficulty maintaining normal wakefulness – both of which can cause a host of medical and psychological problems.
Symptoms Causing Sleep Disorders
There are approximately eighty different types of sleep disorders. They are most often grouped according to behaviors, breathing problems, day-time sleeping patterns and problems with natural sleep-wake cycles. One of the most common symptoms is excessive daytime sleepiness and having trouble falling asleep at night. On the other hand, some people may fall asleep at inappropriate times, such as while driving. Other symptoms include – irregular breathing, irregular sleeping patterns and wake cycle, and unusual or bothersome movements or experiences during sleep.
Types of Sleep Disorders
Sleep disorders prevent you from sleeping well on a regular basis. Occasional sleep disturbances such as jet lag, stress, and a busy schedule may interfere with a person’s sleep. However, if your sleep is disturbed regularly, it may be a sign of a sleep disorder. Here is a look at the six common sleep conditions –
Insomnia – According to the American Psychiatric Association (APA), insomnia is one of the most common of all sleep disorders, with reports suggesting about one-third of adults reporting insomnia symptoms. APA defines insomnia as a disorder in which people have trouble falling asleep or staying asleep. The condition can drain not only energy levels and mood but also affect your health, work performance and quality of life. Insomnia can be either acute (short term) or chronic (long term), based on its duration. Acute insomnia is brief and often happens because of life circumstances and tends to resolve without any treatment. Chronic insomnia, on the other hand, is disrupted sleep that occurs at least three nights per week and lasts at least three months. Treatment for this condition includes behavioral, psychological, medical components or a combination of any of these procedures. Related ICD-10 codes include –
- G47.0 – Insomnia
- G47.00 – Insomnia, unspecified
- G47.01 – Insomnia, due to medical condition
- G47.09 – Other insomnia
Hypersomnia – Also called excessive daytime sleepiness (EDS), hypersomnia refers to a condition in which a person feels excessive sleepiness during the day. People with this sleep disorder can fall asleep at any time. Reports from the National Sleep Foundation suggest that, up to 40% of people have some symptoms of hypersomnia from time to time. The main symptom of hypersomnia is constant tiredness and low energy. Hypersomnia can be primary or secondary. Primary hypersomnia includes diagnoses such as narcolepsy, idiopathic hypersomnia, and Klein-Levin syndrome, while secondary hypersomnia can be a result of other conditions such as depression, obesity, epilepsy, or multiple sclerosis. The condition is most commonly treated with stimulants like amphetamine, methylphenidate and modafinil and positive behavioral changes. ICD-10 codes include –
- G47.1 – Hypersomnia
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- G47.10 – Hypersomnia, unspecified
- G47.11 – Idiopathic hypersomnia with long sleep time
- G47.12 – Idiopathic hypersomnia without long sleep time
- G47.13 – Recurrent hypersomnia
- G47.14 – Recurrent hypersomnia, due to medical condition
- G47.19 – Other hypersomnia
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Circadian rhythm disorders – This sleep disorder occurs due to disruptions in the natural sleep-wake rhythm, referred to as circadian rhythm timing of sleep and wake and the related consequences. When your circadian rhythm is disrupted, it can cause symptoms that range from daytime sleepiness to depression. Other related symptoms include – problems falling asleep, headache, difficulty concentrating, decreased cognitive performance and fatigue. Working overnight shifts and traveling across time zones are among the main factors that can affect your sleep-wake rhythm. Other related factors that influence sleep include – levels of melatonin, (a sleep hormone- which helps regulate sleep), light, levels of physical activity and social activities. Light therapy and sleep medications such as benzodiazepines or non-benzodiazepines hypnotics will be recommended to treat circadian rhythm disorders. ICD-10 codes for diagnosing circadian rhythm disorders are –
- G47.2 – Circadian rhythm sleep disorders
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- G47.20 – Circadian rhythm sleep disorder, unspecified type
- G47.21 – Circadian rhythm sleep disorder, delayed sleep phase type
- G47.22 – Circadian rhythm sleep disorder, advanced sleep phase type
- G47.23 – Circadian rhythm sleep disorder, irregular sleep wake type
- G47.24 – Circadian rhythm sleep disorder, free running type
- G47.25 – Circadian rhythm sleep disorder, jet lag type
- G47.26 – Circadian rhythm sleep disorder, shift work type
- G47.27 – Circadian rhythm sleep disorder in conditions classified elsewhere
- G47.29 – Other circadian rhythm sleep disorder
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Sleep apnea – A potentially serious sleep disorder, sleep apnea occurs when a person’s breathing is repeatedly interrupted during sleep. The involuntary pause in breathing can result either from blocked airway or a signaling problem in the brain. People with this condition will snore loudly and feel tired even after a full night’s sleep. Top causes for this condition include – obesity, large tonsils, premature birth, heart or kidney failure, endocrine disorders, neuromuscular disorders and other genetic syndromes. There are two types of sleep apnea – obstructive and central. Obstructive sleep apnea (OSA) is caused by episodes of complete or partial airway blockage during sleep. In central sleep apnea (CSA), the airway is not blocked, but the brain fails to signal the muscles to breathe. If left untreated sleep apnea can lead to several serious health complications such as heart disease and depression. Mild cases of sleep apnea can be effectively managed by incorporating healthy/positive lifestyle changes such as reducing body weight or quitting the habit of smoking. Medications may be recommended for those who have nasal allergies. ICD-10 codes for sleep apnea include –
- G47.3 – Sleep apnea
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- G47.30 – Sleep apnea, unspecified
- G47.31 – Primary central sleep apnea
- G47.32 – High altitude periodic breathing
- G47.33 – Obstructive sleep apnea (adult) (pediatric)
- G47.34 – Idiopathic sleep related non-obstructive alveolar hypoventilation
- G47.35 – Congenital central alveolar hypoventilation syndrome
- G47.36 – Sleep related hypoventilation in conditions classified elsewhere
- G47.37 – Central sleep apnea in conditions classified elsewhere
- G47.39 – Other sleep apnea
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Narcolepsy – A chronic sleep disorder, narcolepsy is characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with this sleep condition often find it difficult to stay awake for long periods of time, regardless of the circumstances. There are two types of Narcolepsy – Type 1 (Narcolepsy with Cataplexy) and type 2 (Narcolepsy without Cataplexy). Symptoms include muscle weakening or unexpected relaxation of the knees, mouth, eyes drooping, striking dreams or lifelike sleep hallucinations, and sleep paralysis. Medications (stimulants, antidepressants, or other drugs) and other lifestyle changes can help patients manage their symptoms. In addition, taking naps at regular intervals of the day may also reduce excessive sleepiness during the day. ICD-10 codes for this sleep disorder include –
- G47.41 – Narcolepsy
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- G47.411 – Narcolepsy, with cataplexy
- G47.419 – Narcolepsy, without cataplexy
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- 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
Restless legs syndrome (RLS) – Most common among older adults, Restless Leg Syndrome (RLS) is a “creeping” sensation associated with aches and pains throughout the legs and is relieved by movement of the legs. Symptoms include – an uncontrollable urge to move your legs (usually due to an uncomfortable sensation), unpleasant aching, tingling, burning and a feeling that something is crawling in your calves. Medications and behavioral therapy can be used to treat RLS. ICD-10 code is –
- G25.81 – Restless legs syndrome
An early diagnosis and effective therapy can help alleviate the symptoms of sleep disorders in a better manner. In order to promote good sleeping habits, the Centers for Disease Control and Prevention (CDC) recommends that each person should establish a specific routine for bedtime, create a positive sleep environment, avoid large meals, alcohol, smoking and caffeine for at least a few hours before bedtime, and reduce exposure to electronic items. Following these steps will help improve sleep quality.
Healthcare providers need to have adequate knowledge about the specific ICD-10 codes to report common sleep disorders. Utilizing the medical billing services offered by a reliable billing and coding company can help physicians ensure accurate claim submission for optimal reimbursement.
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.