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ICD-10 Guide
ICD-10 CodesF51.12

F51.12

Billable

Insufficient sleep syndrome

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 F51.12 is a billable code used to indicate a diagnosis of insufficient sleep syndrome.

Key Diagnostic Point:

Insufficient sleep syndrome is characterized by a chronic lack of adequate sleep, leading to significant daytime impairment or distress. This condition is not merely a result of lifestyle choices but can stem from various factors including psychological stress, medical conditions, or environmental influences. Patients may experience excessive daytime sleepiness, fatigue, mood disturbances, and cognitive impairments. The syndrome can also exacerbate or contribute to other health issues such as obesity, diabetes, and cardiovascular diseases. Diagnosis typically involves a thorough clinical evaluation, including sleep history, sleep diaries, and possibly polysomnography to rule out other sleep disorders. Treatment may involve lifestyle modifications, cognitive behavioral therapy for insomnia (CBT-I), and in some cases, pharmacotherapy. Understanding the multifaceted nature of insufficient sleep syndrome is crucial for effective management and coding, as it often intersects with other disorders such as anxiety, depression, and various behavioral syndromes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Overlap with other sleep disorders (e.g., insomnia, sleep apnea)
  • Variability in patient presentation and symptoms
  • Need for comprehensive documentation to support diagnosis
  • Potential co-morbid conditions that may complicate coding

Audit Risk Factors

  • Inadequate documentation of sleep history
  • Failure to document co-morbid conditions
  • Lack of evidence for daytime impairment
  • Misclassification with other sleep disorders

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Detailed sleep history, sleep study results, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic fatigue, excessive daytime sleepiness, or mood disturbances.

Billing Considerations

Ensure documentation reflects the impact of insufficient sleep on daily functioning and any co-morbid conditions.

Psychiatry

Documentation Requirements

Mental health assessments, sleep patterns, and any psychological evaluations.

Common Clinical Scenarios

Patients with anxiety or depression presenting with sleep disturbances.

Billing Considerations

Document the interplay between mental health and sleep issues to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use F51.12 When
  • According to ICD
  • 10 guidelines, F51
  • 12 should be used when the patient experiences significant daytime impairment due to insufficient sleep
  • It is important to document the duration and impact of sleep insufficiency, as well as any co
  • existing conditions

Exclusion Criteria

Do NOT use F51.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95806CPT Code

Polysomnography, sleep study

Clinical Scenario

Used to evaluate sleep disorders in patients with insufficient sleep syndrome.

Documentation Requirements

Document indications for the sleep study and results.

Specialty Considerations

Sleep medicine specialists should ensure comprehensive reporting of findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including insufficient sleep syndrome, which helps in better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including insufficient sleep syndrome, which helps in better tracking and management of these conditions.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Academy of Sleep Medicine

Coding & Billing References

  • •
    American Academy of Sleep Medicine

Frequently Asked Questions

What is the primary difference between insufficient sleep syndrome and insomnia?

Insufficient sleep syndrome is characterized by a chronic lack of sleep leading to daytime impairment, while insomnia refers to difficulty falling or staying asleep, which may not necessarily result in daytime dysfunction.