ICD-10 Coding for Nocturnal Hypoxia(G47.36, G47.33, J96.01)
Complete ICD-10-CM coding and documentation guide for Nocturnal Hypoxia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Nocturnal Hypoxia
G47.30-G47.39Primary Range
Sleep disorders related to breathing
This range includes codes for sleep-related breathing disorders, including those causing nocturnal hypoxia.
Respiratory failure, not elsewhere classified
This range includes codes for respiratory failure, which can be associated with severe cases of nocturnal hypoxia.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G47.36 | Sleep-related hypoventilation in conditions classified elsewhere | Use when nocturnal hypoxia is due to a condition other than OSA, such as neuromuscular disorders. |
|
| G47.33 | Obstructive sleep apnea (OSA) | Use when nocturnal hypoxia is due to obstructive sleep apnea. |
|
| J96.01 | Acute hypoxic respiratory failure | Use when nocturnal hypoxia leads to acute respiratory failure. |
|
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 nocturnal hypoxia
Essential facts and insights about Nocturnal Hypoxia
Primary ICD-10-CM Codes for nocturnal hypoxia
Decision Criteria
clinical Criteria
- Presence of nocturnal hypoxemia confirmed by overnight oximetry
coding Criteria
- Underlying condition must be coded first
Applicable To
- Nocturnal hypoxemia due to underlying conditions
Excludes
- Obstructive sleep apnea (G47.33)
Clinical Validation Requirements
- Overnight oximetry showing SpO2 <88% for ≥5 minutes
- Presence of an underlying condition such as neuromuscular disease
Code-Specific Risks
- Confusing with G47.33 when OSA is present
Coding Notes
- Ensure the underlying condition is documented and coded first.
G47.33 - Obstructive sleep apnea (OSA)
Use when nocturnal hypoxia is due to obstructive sleep apnea.
Applicable To
- OSA with hypoxia
Excludes
- Central sleep apnea (G47.31)
Clinical Validation Requirements
- Polysomnography showing AHI ≥5
- Oxygen desaturation index (ODI) ≥5
Coding Notes
Ensure polysomnography results are documented.
J96.01 - Acute hypoxic respiratory failure
Use when nocturnal hypoxia leads to acute respiratory failure.
Applicable To
- Acute respiratory failure with hypoxia
Excludes
- Chronic respiratory failure (J96.10)
Clinical Validation Requirements
- ABG showing PaO2 <60 mmHg
- Requires mechanical ventilation
Coding Notes
Ensure acute onset and ABG results are 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 Nocturnal Hypoxia to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G47.36.
Impact
Clinical: Inaccurate diagnosis of OSA severity., Regulatory: Non-compliance with coding standards., Financial: Potential denial of claims for OSA treatment.
Mitigation Strategy
Ensure polysomnography results are included in the patient's record., Verify AHI and ODI are documented.
Impact
Clinical: Lack of clarity on the underlying cause of hypoxia., Regulatory: Increased audit risk., Financial: Reduced reimbursement due to incorrect DRG assignment.
Mitigation Strategy
Use specific codes that reflect the underlying condition., Document detailed clinical findings.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always code the underlying condition first, such as ALS (G12.21).
Impact
Reimbursement: Incorrect DRG assignment affecting reimbursement., Compliance: Potential audit risk., Data Quality: Misrepresentation of patient condition.
Mitigation Strategy
Use G47.33 for OSA-related hypoxia.
Impact
Using incorrect codes for nocturnal hypoxia can lead to audits.
Mitigation Strategy
Ensure accurate documentation of sleep study results and underlying conditions.
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 Nocturnal Hypoxia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Nocturnal Hypoxia
Use these documentation templates to ensure complete and accurate documentation for Nocturnal Hypoxia. These templates include all required elements for proper coding and billing.
Sleep Medicine Progress Note
Specialty: PulmonologyRequired Elements
- Overnight oximetry results
- Polysomnography findings
- Underlying conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Hospital Discharge Summary
Specialty: Internal MedicineRequired Elements
- ABG results
- Ventilation requirements
- Underlying cause
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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