ICD-10 Coding for Sleeplessness(G47.00, G47.01, F51.05)
Complete ICD-10-CM coding and documentation guide for Sleeplessness. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sleeplessness
G47.00-G47.09Primary Range
Sleep disorders related to insomnia
This range includes codes for different types of insomnia, including unspecified, due to medical conditions, and other specified insomnia.
Nonorganic sleep disorders
This range covers primary insomnia and other nonorganic sleep disorders, including chronic insomnia not due to substance or medical conditions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G47.00 | Unspecified insomnia | Use for initial encounters where the cause of insomnia is not yet determined. |
|
| G47.01 | Insomnia due to medical condition | Use when insomnia is a direct physiological consequence of a documented medical condition. |
|
| F51.05 | Chronic insomnia not due to substance or medical condition | Use for chronic insomnia persisting more than 3 months without a medical or substance-related cause. |
|
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 insomnia due to medical condition
Essential facts and insights about Sleeplessness
Primary ICD-10-CM Codes for sleeplessness
Decision Criteria
clinical Criteria
- Initial presentation of insomnia without clear etiology.
Applicable To
- Initial encounter with unspecified etiology pending workup
Excludes
- Insomnia due to mental disorder (F51.05)
Clinical Validation Requirements
- Differential diagnosis list
- Pending test orders (e.g., TSH, PSG)
Code-Specific Risks
- Using this code for more than 3 visits without specifying etiology can trigger audits.
Coding Notes
- Convert to a more specific code within 3 visits.
G47.01 - Insomnia due to medical condition
Use when insomnia is a direct physiological consequence of a documented medical condition.
Applicable To
- Insomnia directly caused by documented medical condition
Excludes
- Primary insomnia (F51.01)
Clinical Validation Requirements
- Polysomnography showing condition-related arousals
- Medication reconciliation report
Coding Notes
Ensure the medical condition is documented as the primary cause of insomnia.
F51.05 - Chronic insomnia not due to substance or medical condition
Use for chronic insomnia persisting more than 3 months without a medical or substance-related cause.
Applicable To
- Chronic insomnia (>3 months) without medical/substance cause
Excludes
- Insomnia due to medical condition (G47.01)
Clinical Validation Requirements
- 14-day sleep diary
- PHQ-9/GAD-7 to exclude mental health causes
- UDS negative
Coding Notes
Document exclusion of medical causes explicitly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Sleep deprivation
Z72.820Personal history of other diseases of the nervous system and sense organs
Z86.69Problems in relationship with spouse or partner
Z63.0Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Chronic insomnia not due to substance or medical condition
F51.05Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Sleeplessness to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G47.00.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Can result in claim denials and audits., Financial: Potential loss of reimbursement.
Mitigation Strategy
Always document the link between insomnia and the medical condition., Use objective findings to support the diagnosis.
Impact
Reimbursement: Incorrect coding can lead to reduced reimbursement., Compliance: May trigger audits for incorrect coding., Data Quality: Affects the accuracy of patient records and treatment plans.
Mitigation Strategy
Convert to F51.05 if insomnia persists beyond 3 months without a medical cause.
Impact
Failure to sequence codes properly can lead to audits.
Mitigation Strategy
Always code the underlying condition first when using G47.01.
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 Sleeplessness, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sleeplessness
Use these documentation templates to ensure complete and accurate documentation for Sleeplessness. These templates include all required elements for proper coding and billing.
Chronic insomnia without medical cause
Specialty: NeurologyRequired Elements
- Sleep diary showing ≥3 months of symptoms
- Exclusion of medical causes
- Objective sleep study results
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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