ICD-10 Coding for Idiopathic Hypersomnia(G47.11, G47.12)
Complete ICD-10-CM coding and documentation guide for Idiopathic Hypersomnia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Idiopathic Hypersomnia
G47.1Primary Range
Hypersomnia not due to a substance or known physiological condition
This range includes idiopathic hypersomnia with and without long sleep time.
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 patient exhibits excessive sleep duration (>10 hours) with unrefreshing naps. |
|
| G47.12 | Idiopathic hypersomnia without long sleep time | Use when patient has normal sleep duration (6-10 hours) with excessive daytime sleepiness. |
|
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 idiopathic hypersomnia
Essential facts and insights about Idiopathic Hypersomnia
Primary ICD-10-CM Codes for idiopathic hypersomnia
Decision Criteria
clinical Criteria
- Patient reports >10 hours of sleep with unrefreshing naps.
Applicable To
- Hypersomnia with excessive sleep duration
Excludes
- Hypersomnia due to a medical condition
- Narcolepsy
Clinical Validation Requirements
- MSLT mean latency ≤8 min
- 24h PSG total sleep time ≥660 min
- Absence of cataplexy
Code-Specific Risks
- Incorrectly coding as unspecified hypersomnia (G47.10)
Coding Notes
- Ensure documentation specifies sleep duration and test results.
G47.12 - Idiopathic hypersomnia without long sleep time
Use when patient has normal sleep duration (6-10 hours) with excessive daytime sleepiness.
Applicable To
- Hypersomnia with normal sleep duration
Excludes
- Hypersomnia due to a medical condition
- Narcolepsy
Clinical Validation Requirements
- MSLT mean latency ≤8 min
- No SOREMPs on PSG/MSLT
- ESS score ≥14
Coding Notes
Ensure documentation includes ESS score and absence of SOREMPs.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Idiopathic 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 or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Document specific sleep study results., Include symptom frequency and duration.
Impact
Reimbursement: May lead to claim denials due to lack of specificity., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Reduces accuracy of health records.
Mitigation Strategy
Specify G47.11 or G47.12 based on sleep duration.
Impact
Claims may be denied if MSLT and PSG results are not documented.
Mitigation Strategy
Ensure all sleep study results are included in the patient's medical record and attached to claims.
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 Idiopathic Hypersomnia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Idiopathic Hypersomnia
Use these documentation templates to ensure complete and accurate documentation for Idiopathic Hypersomnia. These templates include all required elements for proper coding and billing.
Neurology Progress Note
Specialty: NeurologyRequired Elements
- Assessment of sleep duration
- MSLT and PSG results
- Exclusion of other conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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