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ICD-10 Coding for Insomnia(G47.00, F51.05)

Complete ICD-10-CM coding and documentation guide for Insomnia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Sleep DisorderSleeplessness

Related ICD-10 Code Ranges

Complete code families applicable to Insomnia

G47.00-G47.09Primary Range

Sleep disorders not due to a substance or known physiological condition

Primary range for insomnia coding, covering various types of insomnia not linked to other conditions.

Nonorganic sleep disorders

Covers insomnia related to mental disorders, such as anxiety or depression.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
G47.00Insomnia, unspecifiedUse when insomnia is the primary concern without any mental health comorbidity.
  • Chronic sleep initiation difficulty ≥3 nights/week for ≥3 months
  • Negative mental health review
F51.05Insomnia due to mental disorderUse when insomnia is secondary to a documented mental disorder.
  • Insomnia secondary to generalized anxiety disorder
  • PHQ-9/GAD-7 scores

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

Essential facts and insights about Insomnia

The ICD-10 code for unspecified insomnia is G47.00. For insomnia due to a mental disorder, use F51.05.

Primary ICD-10-CM Codes for insomni

Insomnia, unspecified
Billable Code

Decision Criteria

clinical Criteria

  • Absence of mental health disorder

coding Criteria

  • Primary focus of treatment is insomnia

Applicable To

  • Chronic insomnia without mental health comorbidity

Excludes

  • Insomnia due to mental disorder (F51.05)
  • Insomnia due to alcohol (F10.182)

Clinical Validation Requirements

  • Chronic sleep initiation difficulty ≥3 nights/week for ≥3 months
  • Negative mental health review

Code-Specific Risks

  • Upcoding if mental health comorbidity is present but not documented.

Coding Notes

  • Ensure no mental health comorbidity is present when using this code.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Insomnia due to mental disorder

F51.05
Use when insomnia is secondary to a documented mental disorder such as anxiety or depression.

Insomnia, unspecified

G47.00
Use when insomnia is the primary concern without any mental health comorbidity.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Insomnia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G47.00.

Impact

Clinical: Inadequate treatment planning., Regulatory: Potential audit issues., Financial: Claim denials or reduced reimbursement.

Mitigation Strategy

Use specific phrases like 'difficulty initiating sleep ≥3 nights/week for ≥3 months'., Include validated scale scores.

Impact

Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.

Mitigation Strategy

Use G47.00 for chronic insomnia and R47.83 for acute insomnia (<3 months).

Impact

Improper sequencing of insomnia and mental health codes can trigger audits.

Mitigation Strategy

Follow guidelines for sequencing based on primary focus of treatment.

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 Insomnia, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Insomnia

Use these documentation templates to ensure complete and accurate documentation for Insomnia. These templates include all required elements for proper coding and billing.

Chronic Insomnia

Specialty: Neurology

Required Elements

  • Onset and duration of symptoms
  • Frequency of insomnia episodes
  • Sleep log data
  • Epworth Sleepiness Scale score

Example Documentation

Patient reports difficulty initiating sleep ≥5 nights/week for 6 months, Epworth Sleepiness Scale 14/24, negative for OSA symptoms.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has trouble sleeping.
Good Documentation Example
Patient reports difficulty falling asleep 5 nights/week for 4 months, Epworth score 14.
Explanation
The good example provides specific frequency, duration, and a validated scale score.

Need help with ICD-10 coding for Insomnia? Ask your questions below.

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