ICD-10 Coding for Excessive Daytime Sleepiness(R40.0, G47.10, G47.33, G47.419)
Complete ICD-10-CM coding and documentation guide for Excessive Daytime Sleepiness. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Excessive Daytime Sleepiness
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R40.0 | Somnolence | Use when EDS is present without a confirmed diagnosis of a specific sleep disorder. |
|
| G47.10 | Hypersomnia, unspecified | Use when hypersomnia is diagnosed but not specified as idiopathic or due to another condition. |
|
| G47.33 | Obstructive sleep apnea (adult) (pediatric) | Use when OSA is confirmed with polysomnography. |
|
| G47.419 | Narcolepsy, unspecified | Use when narcolepsy is confirmed with MSLT showing ≤8 min latency and ≥2 SOREMPs. |
|
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 excessive daytime sleepiness
Essential facts and insights about Excessive Daytime Sleepiness
Primary ICD-10-CM Codes for excessive daytime sleepiness
Decision Criteria
clinical Criteria
- ESS >10 with no specific sleep disorder diagnosis
Clinical Validation Requirements
- Epworth Sleepiness Scale (ESS) >10
- No formal sleep study confirming specific disorder
Code-Specific Risks
- Using R40.0 when a definitive diagnosis exists can lead to incorrect coding.
Coding Notes
- R40.0 should not be used if a specific sleep disorder is diagnosed.
G47.10 - Hypersomnia, unspecified
Use when hypersomnia is diagnosed but not specified as idiopathic or due to another condition.
Applicable To
- Idiopathic hypersomnia
Excludes
- Narcolepsy (G47.419)
Clinical Validation Requirements
- MSLT <8 min sleep latency
- >660 min total sleep time
Coding Notes
Ensure proper sleep study documentation is available.
G47.33 - Obstructive sleep apnea (adult) (pediatric)
Use when OSA is confirmed with polysomnography.
Applicable To
- OSA-related EDS
Excludes
- Central sleep apnea (G47.31)
Clinical Validation Requirements
- AHI ≥5
- ESS ≥10
Coding Notes
Ensure polysomnography results are documented.
G47.419 - Narcolepsy, unspecified
Use when narcolepsy is confirmed with MSLT showing ≤8 min latency and ≥2 SOREMPs.
Applicable To
- Narcolepsy with EDS
Excludes
- Hypersomnia (G47.10-G47.11)
Clinical Validation Requirements
- MSLT ≤8 min
- ≥2 SOREMPs
Coding Notes
Document MSLT results and any additional findings like cataplexy.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Excessive Daytime Sleepiness to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R40.0.
Impact
Clinical: May lead to misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials due to insufficient documentation.
Mitigation Strategy
Use specific scales like ESS, Document sleep study results
Impact
Reimbursement: Incorrect coding can lead to denied claims or reduced reimbursement., Compliance: May result in non-compliance with coding guidelines., Data Quality: Affects the accuracy of clinical data and reporting.
Mitigation Strategy
Use specific codes like G47.33 for OSA or G47.419 for narcolepsy when confirmed.
Impact
R40.0 used without ESS scores or sleep study results.
Mitigation Strategy
Ensure all EDS documentation includes quantitative measures.
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 Excessive Daytime Sleepiness, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Excessive Daytime Sleepiness
Use these documentation templates to ensure complete and accurate documentation for Excessive Daytime Sleepiness. These templates include all required elements for proper coding and billing.
EDS with suspected sleep disorder
Specialty: Sleep MedicineRequired Elements
- ESS score
- Sleep study results
- Exclusion of other conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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