Understanding Sleep Disorders

Becky Buegel, RHIA, CDIP, CHP Medical Coding Leave a Comment

Understanding Sleep Disorders

Were you aware that while you sleep, your brain and body functions, like your lungs breathing and heart beating, are still operating? These important functions assist in keeping you not only alive but healthy and performing at your best. Not receiving enough quality sleep doesn’t just leave you feeling tired; it can ultimately affect your mental and physical health, including your ability to think and function properly.

Lack of proper sleep can lead to sleep disorders. What exactly, you may ask are sleep disorders? Sleep disorders are conditions that disrupt your normal sleep patterns. At present, there are more than 80 recognized sleep disorders. While it isn’t possible to list and describe all known sleep disorders in this short blog, major sleep disorders include:

  • Insomnia – Defined as the inability to fall asleep and stay asleep; often involves early morning awakening and inability to resume sleep
  • Restless Legs Syndrome (RLS) – An unpleasant creeping tingling/prickly sensation in the legs; includes a powerful urge to move the legs. RLS is associated with late-stage kidney disease, iron deficiency, neuropathy, MS, and Parkinson’s, though the cause of most RLS diagnoses is unknown.
  • Periodic Limb Movement Disorder (PLMD) – Repetitive flexing or twitching of limbs while asleep; patients are often unaware of the movements. Causes can include DM, iron deficiency, spinal cord injury, anemia, and uremia, along with certain medication side effects.
  • Narcolepsy – Excessive daytime sleepiness combined with sudden muscle weakness; sudden muscle weakness could be prompted by strong emotions or surprise. Narcolepsy has been described as “sleep attacks.”
  • Sleep apnea – Actually a breathing disorder that can cause a cessation in breathing for 10 or more seconds during sleep. Treatment is dependent on the cause of the sleep apnea, and if it is due to an underlying medical condition such as CHF, the apnea may likely resolve once the underlying condition is treated.
  • Obstructive sleep apnea (OSA) – Caused by a physical obstruction, such as enlarged tonsils or adenoids, blocking the upper airway. Other causes can be due to advanced heart or kidney failure, facial structure abnormalities like cleft palate, and obesity. CPAP – continuous positive airway pressure therapy is the most effective treatment.
  • Central sleep apnea (CSA) – Choking episodes can occur during the night if the brain stops sending signals to the muscles that control breathing. Obesity is a common cause, though CSA can also be a side-effect of a stroke, brain infection, or other medical problems with the brain stem. Narcotic painkillers and other sleep-inducing medications can also contribute to CSA. CPAP is often the treatment of choice, though many patients find BiPAP (bi-level positive air pressure) more effective.
  • REM sleep behavior disorder – REM (rapid eye movement) is the sleep stage where dreaming occurs. The body experiences temporary paralysis of most of the muscles during dreaming, thus allowing quiet, safe dreaming. REM sleep behavior disorder does just the opposite; the body, including the voice, performs the dreams while one remains asleep. An uncommon disorder (less than 1% of people experience this disorder) it usually begins after age 50 and is often associated with Parkinson’s disease, Lewy body dementia, and multiple system atrophy. Often worsening with time, the REM sleep behavior disorder requires treatment so as to reduce the risk of injury to both the patient and their bed partner.

Treatment for sleep disorders depends on the type of disorder, any underlying or contributing causes, and the person themselves. Patients often use machines known as CPAP (continuous positive airway pressure) or BiPAP (bilevel positive airway pressure). CPAP is a machine that uses mild air pressure to keep breathing airways open when sleeping. BiPAP normalizes breathing by delivering pressurized air1 into the upper airway that leads to the lungs. The bilevel design provides two different levels of air pressure: one for breathing in and one for breathing out.

ICD-10-CM Coding Chart

NARRATIVE DIAGNOSIS

ICD-10-CM

CODE

CODING NOTE

APNEA

 

G47.3+

Code also any underlying condition

EXCLUDES:

Apnea NOS (R06.81)

Cheyne-Stokes breathing (R06.3)

pickwickian Syndrome (E66.2)

sleep apnea of newborn (P28.3-)

Sleep apnea unspecified

Sleep apnea NOS

G47.30

 

Primary central sleep apnea

Idiopathic central sleep apnea

G47.31

 

Obstructive sleep apnea (adult) (pediatric)

Obstructive sleep apnea hypopnea

G47.33

EXCLUDES: obstructive sleep apnea of newborn (P28.3-)

Central sleep apnea in conditions classified elsewhere

G47.37

Code first underlying condition

Other sleep apnea

G47.39

 

 

 

 

INSOMNIA

G47.0+

 

Unspecified

Insomnia NOS

G47.00

 

Due to medical condition

G47.01

Code also associated medical condition

Other insomnia

G47.09

 

 

 

 

NARCOLEPSY

G47.41+

 

With cataplexy

G47.411

 

Without cataplexy

Narcolepsy NOS

G47.419

 

In conditions classified elsewhere

G47.42+

Code first

underlying condition

With cataplexy

G47.421

 

Without cataplexy

G47.429

 

 

 

 

SLEEP RELATED MOVEMENT DISORDER

G47.6+

Excludes restless legs syndrome (G25.81)

PLMD

G47.61

 

 

 

 

OTHER SPECIFIED EXTRA-PYRAMIDAL AND MOVEMENT DISORDERS

G25.8+

 

Restless legs syndrome

G25.81

 

 

 

 

PARASOMNIA

G47.5+

Check Tabular for multiple excludes codes

REM Sleep Behavior Disorder

G47.52

 

References:

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