ICD-10 Coding for Narcolepsy(G47.411, G47.419)
Complete ICD-10-CM coding and documentation guide for Narcolepsy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Narcolepsy
G47.4Primary Range
Sleep disorders
This range includes all codes related to narcolepsy and its variants.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G47.411 | Narcolepsy with cataplexy | Use when cataplexy is documented with MSLT or CSF findings. |
|
| G47.419 | Narcolepsy without cataplexy | Use when narcolepsy is confirmed without cataplexy. |
|
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 narcolepsy with cataplexy
Essential facts and insights about Narcolepsy
Primary ICD-10-CM Codes for narcolepsy
Decision Criteria
clinical Criteria
- Presence of cataplexy and MSLT findings
Clinical Validation Requirements
- MSLT showing mean sleep latency ≤8 minutes with ≥2 SOREMPs
- CSF hypocretin-1 levels ≤110 pg/mL
Code-Specific Risks
- Misclassification without proper MSLT or CSF results
Coding Notes
- Ensure cataplexy is confirmed with video or EEG.
G47.419 - Narcolepsy without cataplexy
Use when narcolepsy is confirmed without cataplexy.
Applicable To
- Narcolepsy type 2
Excludes
- Sleep apnea (G47.33)
Clinical Validation Requirements
- MSLT showing mean sleep latency ≤8 minutes with ≥2 SOREMPs
Coding Notes
Ensure absence of cataplexy is documented.
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 Narcolepsy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G47.411.
Impact
Clinical: Misdiagnosis of narcolepsy type, Regulatory: Non-compliance with documentation standards, Financial: Potential claim denials
Mitigation Strategy
Use video or EEG to confirm cataplexy, Document episodes clearly
Impact
Reimbursement: Potential denial of claims, Compliance: Non-compliance with coding standards, Data Quality: Inaccurate clinical data
Mitigation Strategy
Always confirm with MSLT or CSF hypocretin levels.
Impact
Incomplete MSLT documentation can lead to audit issues.
Mitigation Strategy
Ensure all MSLT results are fully documented and meet criteria.
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 Narcolepsy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Narcolepsy
Use these documentation templates to ensure complete and accurate documentation for Narcolepsy. These templates include all required elements for proper coding and billing.
Initial diagnosis of narcolepsy
Specialty: NeurologyRequired Elements
- Patient history of sleep attacks
- MSLT results
- CSF hypocretin levels
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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