ICD-10 Coding for Hypersomnia(G47.11, G47.12, G47.14)
Complete ICD-10-CM coding and documentation guide for Hypersomnia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypersomnia
G47.1Primary Range
Hypersomnia
This range includes all primary codes for hypersomnia, covering idiopathic and secondary forms.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G47.11 | Idiopathic hypersomnia with long sleep time | Use when the patient has idiopathic hypersomnia with documented long sleep time. |
|
| G47.12 | Idiopathic hypersomnia without long sleep time | Use when the patient has idiopathic hypersomnia without long sleep time. |
|
| G47.14 | Hypersomnia due to medical condition | Use when hypersomnia is secondary to another medical condition. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hypersomnia
Essential facts and insights about Hypersomnia
Primary ICD-10-CM Codes for hypersomnia
Decision Criteria
clinical Criteria
- Documented sleep time >10 hours per 24 hours
Applicable To
- Idiopathic hypersomnia with sleep time >10 hours per 24 hours
Excludes
- Hypersomnia due to medical condition (G47.14)
Clinical Validation Requirements
- Actigraphy showing ≥660 min sleep/24h
- MSLT average latency ≤8 min
- Absence of SOREMPs on PSG/MSLT
Code-Specific Risks
- Misclassification if sleep time is not accurately documented.
Coding Notes
- Ensure sleep time is documented over a sufficient period to support the diagnosis.
G47.12 - Idiopathic hypersomnia without long sleep time
Use when the patient has idiopathic hypersomnia without long sleep time.
Applicable To
- Idiopathic hypersomnia with sleep time <10 hours per 24 hours
Excludes
- Hypersomnia due to medical condition (G47.14)
Clinical Validation Requirements
- MSLT average latency ≤8 min
- Total sleep time <660 min/24h
- Presence of sleep inertia
Coding Notes
Ensure documentation of sleep inertia and total sleep time.
G47.14 - Hypersomnia due to medical condition
Use when hypersomnia is secondary to another medical condition.
Applicable To
- Hypersomnia secondary to another medical condition
Excludes
- Idiopathic hypersomnia (G47.11, G47.12)
Clinical Validation Requirements
- Explicit link to underlying medical condition
- Underlying condition coded first
Coding Notes
Ensure the underlying condition is documented and coded.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Somnolence
R40.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypersomnia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G47.11.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims.
Mitigation Strategy
Ensure polysomnography results are included., Document negative findings for other disorders.
Impact
Reimbursement: May lead to denials if unspecified codes are used., Compliance: Non-compliance with coding specificity requirements., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Specify 'idiopathic' or 'due to...' per testing.
Impact
Lack of detailed sleep study results can trigger audits.
Mitigation Strategy
Ensure all sleep study results are documented and linked to the diagnosis.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Hypersomnia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypersomnia
Use these documentation templates to ensure complete and accurate documentation for Hypersomnia. These templates include all required elements for proper coding and billing.
Idiopathic Hypersomnia with Long Sleep Time
Specialty: NeurologyRequired Elements
- Patient symptoms
- Diagnostic test results
- Exclusion of other conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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