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ICD-10: Insomnia

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~Risa Lavizzo-Mourey

Can’t sleep? Constantly tossing and turning? You lie down for bed but your racing mind keeps you awake. But you have to work in the morning! There’s no way you can be productive and efficient at work if you can’t fall or stay asleep. What is going on with you?!

If you have a hard time falling and/or staying asleep at night most, if not every night, there is a good possibility that you have insomnia. If so, there are plenty of tools you can use to help you get a good night’s sleep. But before you can partake in these resources, you’ll probably need an “official” insomnia diagnosis from your doctor.

Content

Insomnia

Insomnia is a sleep disorder that makes it difficult, if not impossible, to fall asleep and/or stay asleep throughout the night. If you have insomnia, it may take you a long time to drift-off, lead to frequent wake-ups in the middle of the night, trigger constant tossing and turning, and/or cause you to awaken feeling fatigued, groggy, and disorientated.

Acute insomnia is a type of insomnia that occurs infrequently. In other words, you may experience, but never again. Chronic insomnia, on the other hand, typically lasts a long time or reoccurs regularly or many times. Acute insomnia is most prevalent in women over the age of 60.

Types of Insomnia

There are two types of insomnia – primary and secondary.

  • Primary insomnia is an inability to fall and/or stay asleep because of internal and external factors, such as noise, light, atmosphere, work-related, relationship, or personal stress, temperature, or the loss of someone or something.
  • Secondary insomnia is an inability to fall and/or stay asleep because of an ailment or health condition, such as lupus, anxiety, depression, asthma, restless leg syndrome (RLS), cancer, arthritis, chronic fatigue syndrome, chronic pain, influenza, dementia or Alzheimer’s syndrome, thyroid problems, etc.

Symptoms & Diagnosis

Insomnia typically involves staying up late at night because you are unable to fall asleep, waking-up throughout the night, struggling with daytime grogginess and fatigue, being easily irritated, annoyed, or frustrated, and waking-up too early. If you are experiencing any of these symptoms it may be time to talk to your doctor about your sleep concerns.

He or she will assess your symptoms – i.e. poor sleep quality, daytime fatigue and grogginess, a lack of motivation, an inability to focus or concentrate or complete tasks in a timely manner, anxiety or constant worrying over not being able to fall and/or stay asleep.

Then, your doctor will perform a physical exam and ask you about your medical history and experiences to determine why you are experiencing insomnia. He or she may also order a sleep study to evaluate your sleep patterns.

Insomnia ICD-10 Codes & Guidelines

Insomnia ICD-10 and guidelines can be found in the ICD-10 CM Manual – Chapter 5 (Mental and Behavioral Disorders – Codes: F01-F99) and Chapter 6 (Diseases of the Nervous System – Codes: G00-G99).

Note: Check the “Exclusion Notes” before coding insomnia because some insomnia-related symptoms and conditions may also be separately coded. For instance, even though unspecified insomnia is ICD G47.00, certain components of this condition should also be coded.

Such as, if night terrors or nightmares or sleepwalking is present, then F51 codes should also be coded with the G47.00. Also, if sleep apnea is linked to drug-induced insomnia, the code should be G47.00, along with a F11-F19 code, depending on the substance.

Insomnia
Insomnia G47.00
Insomnia/hyposomnia due to a health condition G47.01
Insomnia, unspecified G47.09
Idiopathic insomnia

  • Non-organic origin
  • Primary
  • Not due to a health condition or substance abuse
F51.01
Short-term insomnia

  • Transient
  • Adjustment-related
  • Stress-related
F51.02
Paradoxical insomnia F51.03
Chronic insomnia
Conditioned insomnia
Psychophysiological insomnia
F51.04
Insomnia due to depression, anxiety, or another mental health condition
Psychiatric insomnia
F51.05
Insomnia not due to a health condition or substance abuse, but specified F51.09
Insomnia due to alcohol:

  • Abuse
  • Dependence
  • Use
F10.182
F10.282
F10.982
Insomnia due to opioids:

  • Abuse
  • Dependence
  • Use
F11.182
F11.282
F11.982
Insomnia due to sedative, anxiolytic or hypnotic factors:

  • Abuse
  • Dependence
  • Use
F13.182
F13.282
F13.982
Insomnia due to cocaine:

  • Abuse
  • Dependence
  • Use
F14.182
F14.282
F14.982
Insomnia due to Amphetamines, caffeine, or another stimulant such as:

  • Abuse
  • Dependence
  • Use
F15.182
F15.282
F15.982
Insomnia due to psychoactive substances:

  • Abuse
  • Dependence
  • Use
F19.182
F19.282
F19.982
Childhood behavioral insomnia Z73.810 – Z73.819
Fatal familial insomnia A81.83

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ICD-10 Insomnia Case Studies

Listed below are two ICD-10 insomnia case studies:

Michael

Michael, a 45-year-old married man, sought treatment because he had been unable to sleep for 3 months. Michael reported that his problems began after his twin brother died from a car accident. He had never had a hard time sleeping before his brother’s death. By the time Michael sought treatment he was drinking between four and five cups of coffee each day and two pegs (60 ml) of whiskey before bed every night.

Michael’s wife reported that Michael sometimes suffers from “shaky or jerky legs” while asleep. However, he does not appear to have any chronic illnesses. On the day of his doctor’s visit, Michael’s vitals were normal. And, after a full physical exam nothing was deemed “abnormal” or “irregular.” After the assessment, Michael’s doctor coded his condition as “adjustment disorder” (F43.20).

Michael’s condition was incorrectly coded. The ICD-10 code should have been F51.02 (adjustment-related insomnia).

Jennifer

Jennifer, a 20-year-old college student, who, at the time, was pursuing a business administration degree, sought treatment after struggling with waking-up too early every morning. Jennifer left home around 7:00 am each morning to attend her first class at 8:00 am. The problem was she kept waking up at 3:00 am each morning from a nightmare. After awakening, Jennifer was unable to fall back asleep so she would end-up being up until bedtime. Then, she’d be stressed, tired, and irritable at work.

When Jennifer presented the “sleeplessness” had been occurring for over a week and she was exhausted. She was desperate for relief. Jennifer did not appear to have a history of insomnia and did not partake in drugs or alcohol. During her initial visit her vitals were normal. The doctor performed a full physical exam on Jennifer and found that she was a healthy young lady with no cognitive deficits.

Jennifer’s doctor also ordered a neurological screen to be completed with a behavioral health specialist. And, after the exams, he coded her condition as “unspecified insomnia with nightmares” (G47.00 & F51.5). He prescribed Jennifer a week’s worth of Ambien and instructed her to follow-up with him in about a week.

Jennifer’s condition was coded correctly.

Note: The nightmare aspect of the insomnia was coded separately, as instructed in the “Exclusion Notes.”

Sleep Disorders the Can Trigger Insomnia

Hypersomnia (NOS) G47.10
Hypersomnia due to a health condition G47.14
Narcolepsy with cataplexy G47.411
Narcolepsy without cataplexy G47.419
Recurrent hypersomnia G47.13
Idiopathic hypersomnia with prolonged sleep time G47.11
Idiopathic hypersomnia without prolonged sleep time G47.12
Primary hypersomnia F51.11
Poor sleep syndrome F51.12
Hypersomnia not due to a substance or known health condition F51.19
Sleep-Related Breathing Disorders
Obstructive sleep apnea G47.33
Sleep-related non-obstructive alveolar hypoventilation G47.34
Obesity hypoventilation syndrome E66.2
Sleep-related hypoventilation/hypoxemia G47.36
Primary central sleep apnea G47.31
Cheyne stokes breathing patterns R06.3
Central sleep apnea/complex sleep apnea G47.37
Sleep apnea, unspecified G47.39
Dyspnea, unspecified R06.00
Other forms of dyspnea R06.09
Periodic breathing R06.3
Snoring R06.83
Other breathing abnormalities R06.89
Apnea, unspecified R06.81
Sleep apnea, unspecified G47.30
Circadian Rhythm Sleep Disorders (NOS) G47.20
Delayed-sleep G47.21
Advanced-sleep G47.22
Irregular sleep/wake G47.23
Free-running G47.24
Shift work (Shift work disorder) G47.26
Parasomnias
Confused arousals G47.51
Sleep-walking F51.3
Night terrors F51.4
REM sleep behavior disorder G47.52
Recurrent isolated sleep paralysis G47.53
Nightmare disorder F51.5
Other sleep disorders not due to a substance or known health condition F51.8
Another parasomnia G47.59
Sleep-Related Movement Disorders
Restless legs syndrome (RLS) G25.81
Periodic limb movement disorder G47.61
Sleep-related leg cramps G47.62
Sleep-related bruxism G47.63
Drug-Induced Sleep Disorders
Sleep disorder due to opioid abuse F11.182
Sleep disorder due to opioid dependence F11.282
Sleep disorder due to opioid use, unspecified F11.982
Sleep disorder due to sedative, hypnotic or anxiolytic abuse F13.182
Sleep disorder due to sedative, hypnotic or anxiolytic dependence F13.282
Sleep disorder due to sedative, hypnotic or anxiolytic use, unspecified F13.982
Sleep disorder due to cocaine abuse F14.182
Sleep disorder due to cocaine dependence F14.282
Sleep disorder due to cocaine use, unspecified F14.982
Sleep disorder due to stimulant abuse F15.182
Sleep disorder due to stimulant dependence F15.282
Sleep disorder due to stimulant use, unspecified F15.982
Sleep disorder due to psychoactive substance abuse F19.182
Sleep disorder due to psychoactive substance dependence, in remission F19.21
Sleep disorder due to psychoactive substance dependence F19.282
Sleep disorder due to psychoactive substance use, unspecified F19.982

Summary

Getting a proper diagnosis is extremely important with an ailment or condition – even insomnia. ICD codes can help doctors classify and identify your insomnia signs and symptoms, any atypical findings, triggers, and external factors. The goal of ICD-10 codes in insomnia studies is to help develop medications and tools and resources to improve your sleep quality so you can fall peacefully asleep and stay asleep throughout the night.

One of the benefits of ICD-10 codes is they have the ability to lower your assessment and treatment costs. They can also be used during research studies to identify ailments and health conditions. Without the proper codes, your health insurance may not pay for the cost of visits, tests, or treatment. There is also a risk that you could be prescribed the wrong medications or treatment plan.

Thus, it is important that your doctor notate the correct ICD-10 code(s) for your form of insomnia. Because, the last thing you want is to be misdiagnosed or miscoded when trying to find a remedy for your “sleeplessness.”

References

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