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ICD-10 Guide
ICD-10 CodesG47.1

G47.1

Billable

Hypersomnia

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

Code Description

ICD-10 G47.1 is a billable code used to indicate a diagnosis of hypersomnia.

Key Diagnostic Point:

Hypersomnia is characterized by excessive daytime sleepiness, which can significantly impact daily functioning and quality of life. This condition can manifest as prolonged nighttime sleep or recurrent episodes of sleep during the day. It may be primary, such as in idiopathic hypersomnia, or secondary to other conditions like sleep apnea, narcolepsy, or psychiatric disorders. Patients often report difficulty waking up, feeling unrefreshed after sleep, and experiencing cognitive impairments. The diagnosis typically involves a thorough clinical evaluation, including sleep history, physical examination, and possibly polysomnography or multiple sleep latency tests to differentiate it from other sleep disorders. Treatment may include lifestyle modifications, stimulant medications, or addressing underlying conditions contributing to hypersomnia. Understanding the nuances of hypersomnia is crucial for accurate diagnosis and effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary hypersomnia.
  • Need for comprehensive sleep study interpretation.
  • Potential overlap with other sleep disorders like sleep apnea and narcolepsy.
  • Variability in patient presentation and symptomatology.

Audit Risk Factors

  • Inadequate documentation of sleep study results.
  • Failure to specify whether hypersomnia is primary or secondary.
  • Lack of detailed patient history regarding sleep patterns.
  • Misclassification of hypersomnia as another sleep disorder.

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Comprehensive sleep history, results from polysomnography, and any relevant comorbid conditions.

Common Clinical Scenarios

Patients presenting with excessive daytime sleepiness, history of sleep apnea, or narcolepsy.

Billing Considerations

Ensure clear documentation of the type of hypersomnia and any treatments attempted.

Neurology

Documentation Requirements

Neurological examination findings, history of neurological disorders, and sleep study results.

Common Clinical Scenarios

Patients with neurological conditions presenting with hypersomnia symptoms.

Billing Considerations

Document any neurological assessments that may contribute to the diagnosis.

Coding Guidelines

Inclusion Criteria

Use G47.1 When
  • According to ICD
  • 10 guidelines, G47
  • 1 should be used when hypersomnia is the primary diagnosis
  • It is important to document the duration and frequency of symptoms, as well as any associated conditions

Exclusion Criteria

Do NOT use G47.1 When
  • Exclusion criteria include conditions that cause excessive sleepiness but are not classified as hypersomnia

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

Used to diagnose hypersomnia and differentiate from other sleep disorders.

Documentation Requirements

Document the reason for the sleep study and results.

Specialty Considerations

Sleep 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 hypersomnia, enabling better tracking of sleep disorders and their management. This specificity aids in research and improves patient care by allowing for tailored treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hypersomnia, enabling better tracking of sleep disorders and their management. This specificity aids in research and improves patient care by allowing for tailored treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hypersomnia, enabling better tracking of sleep disorders and their management. This specificity aids in research and improves patient care by allowing for tailored treatment plans.

Resources

Clinical References

  • •
    American Academy of Sleep Medicine

Coding & Billing References

  • •
    American Academy of Sleep Medicine

Frequently Asked Questions

What is the difference between hypersomnia and narcolepsy?

Hypersomnia is characterized by excessive daytime sleepiness, which can be primary or secondary to other conditions, while narcolepsy is a specific disorder that includes symptoms such as cataplexy and sleep attacks. Narcolepsy is classified under G47.10, whereas hypersomnia is coded as G47.1.