Journal of AHIMA - May 2011

ICSD- 2 Diagnostic Criteria Example

ICSD- 2 DEFINES IDIOPATHIC hypersomnia with long sleep time as a patient with prolonged nocturnal sleep time (more than 10 hours) documented by interview, actigraphy, or sleep logs. Waking in the morning or from a nap is almost always laborious.

ICSD- 2 defines idiopathic hypersomnia without long sleep time as a patient with normal nocturnal sleep (greater than six hours but less than 10 hours) documented by interview, actigraphy, or sleep logs.

Coding professionals can consult the reference to help identify the appropriate ICD-9-CM and ICD-10-CM codes for these diagnoses.

ICSD- 2

Idiopathic hypersomnia with long sleep time Idiopathic hypersomnia without long sleep time

ICD-9-CM CODE

327.11, Idiopathic hypersomnia, with long sleep time

327.12, Idiopathic hypersomnia, without long sleep time

ICD-10-CM CODE

G47.11, Idiopathic hypersomnia, with long sleep time G47.12, Idiopathic hypersomnia, without long sleep time

To support advances in sleep medicine technology, two new CPT codes have been added to report unattended sleep studies. CPT code 95800 is reported for an unattended sleep study with simultaneous recording of heart rate, oxygen saturation, respiratory analysis, and sleep time. Code 95801 is reported for an unattended sleep study with simultaneous recording of minimum heart rate, oxygen saturation, and respiratory analysis.

The new codes differ in that code 95801 measures the minimum heart rate and does not include sleep time. Prior to the new codes, unattended sleep studies were reported using CPT category III codes 0203T and 0204T.

In addition, the Office of Inspector General plans to continue investigating the factors that have contributed to the rise in Medicare payments for polysomnography, which increased from $62 million in 2001 to $235 million in 2009. OIG will review the Medicare payments for sleep test procedures provided at sleep disorder clinics for compliance with federal program requirements and Medicare Part B coverage requirements.

OIG has identified improper payments when certain modifiers are not reported with sleep test procedures and will review Medicare payments to physicians and independent diagnostic testing facilities for sleep test procedures to determine compliance with Medicare requirements.

Coding Classifications for Sleep Disorders

The International Classification of Sleep Disorders (ICSD- 2) provides clinician diagnostic criteria, essential and associated features, and differential diagnoses. It includes more than 80 specific sleep disorder diagnoses within eight major categories.

The eight ICSD- 2 diagnostic categories include insomnias, sleep-related breathing disorders, hypersomnias of central origin, circadian rhythm sleep disorders, parasomnias, sleep-related movement disorders, isolated symptoms and normal variants, and other sleep disorders.

ICSD- 2 also includes two appendices for classification of sleep disorders associated with medical or psychiatric disorders.

Although the ICD-9-CM coding classification system has been
updated to include new sleep disorder codes to be consistent
with ICSD- 2, the clinical enhancements in ICD-10-CM incor-
porate even more up-to-date sleep disorders and code specific-
ity than ICD-9-CM. The diagnostic codes in the fourth edition
of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) has also been updated to be compatible with ICSD-
2, since sleep disorder symptoms may accompany psychiatric
disorders.

Note

1. Department of Health and Human Services. “Sleep Health.” www.healthypeople.gov/2020/topicsobjectives20 20/ overview.aspx?topicid= 38.

References

American Academy of Sleep Medicine. www.aasmnet.org.

American Academy of Sleep Medicine. International Classification of Sleep Disorders, 2nd ed.: Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine, 2005.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association, 2000.

Department of Health and Human Services, Office of Inspector General. “Office of Inspector General Work Plan: Fiscal Year 2011.” http://oig.hhs.gov/publications/workplan/2011/FY11 _WorkPlan-All.pdf.

Kentucky Sleep Society. “CMS Approves AASM Request for a Medicare Physician Specialty Code for Sleep Medicine.” www.kyss.org/files/NewsletterFeb2011.pdf.