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ICD-10 Guide
ICD-10 CodesG47.01

G47.01

Billable

Insomnia due to medical condition

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

Code Description

ICD-10 G47.01 is a billable code used to indicate a diagnosis of insomnia due to medical condition.

Key Diagnostic Point:

Insomnia due to medical condition is characterized by difficulty falling asleep, staying asleep, or waking up too early, which is directly attributable to an underlying medical condition. This condition can arise from various health issues, including chronic pain, respiratory disorders, neurological conditions, and psychiatric disorders. The insomnia experienced is often a secondary symptom, exacerbated by the primary medical condition. For instance, patients with chronic obstructive pulmonary disease (COPD) may experience insomnia due to breathing difficulties at night, while those with chronic pain conditions may find it hard to sleep due to discomfort. The diagnosis of insomnia due to a medical condition requires a thorough evaluation of the patient's medical history, a review of their current medications, and an assessment of their sleep patterns. Treatment typically focuses on managing the underlying medical condition while employing behavioral strategies and, if necessary, pharmacological interventions to improve sleep quality.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires thorough documentation of the underlying medical condition.
  • Differentiating between primary insomnia and insomnia secondary to a medical condition.
  • Potential overlap with other sleep disorders such as sleep apnea.
  • Need for comprehensive patient history and sleep study results.

Audit Risk Factors

  • Inadequate documentation linking insomnia to the medical condition.
  • Failure to document the patient's sleep history and treatment response.
  • Misclassification of insomnia type (primary vs. secondary).
  • Inconsistent coding of co-existing sleep disorders.

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Detailed sleep history, results from sleep studies, and treatment plans.

Common Clinical Scenarios

Patients presenting with insomnia alongside conditions like sleep apnea or restless leg syndrome.

Billing Considerations

Ensure that the relationship between the insomnia and the medical condition is clearly documented.

Pulmonology

Documentation Requirements

Documentation of respiratory conditions and their impact on sleep quality.

Common Clinical Scenarios

Patients with COPD or asthma experiencing insomnia due to nocturnal symptoms.

Billing Considerations

Linking respiratory symptoms to sleep disturbances is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use G47.01 When
  • According to ICD
  • 10 coding guidelines, G47
  • 01 should be used when insomnia is directly linked to a medical condition
  • Coders must ensure that the medical record clearly indicates this relationship

Exclusion Criteria

Do NOT use G47.01 When
  • Exclusion criteria include cases where insomnia is not attributable to a medical condition or is classified under primary insomnia

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography

Clinical Scenario

Used to evaluate sleep disorders including insomnia due to medical conditions.

Documentation Requirements

Results of the sleep study must be documented, including any findings related to the underlying medical condition.

Specialty Considerations

Sleep specialists should ensure that the sleep study results are clearly linked to the diagnosis of insomnia.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of insomnia related to medical conditions, improving the accuracy of diagnoses and treatment plans. This specificity helps in better understanding the prevalence and impact of insomnia in patients with various medical conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of insomnia related to medical conditions, improving the accuracy of diagnoses and treatment plans. This specificity helps in better understanding the prevalence and impact of insomnia in patients with various medical conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of insomnia related to medical conditions, improving the accuracy of diagnoses and treatment plans. This specificity helps in better understanding the prevalence and impact of insomnia in patients with various medical conditions.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between G47.01 and G47.00?

G47.01 is used when insomnia is specifically due to a medical condition, while G47.00 is for unspecified insomnia without a clear medical cause.