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ICD-10 Guide
ICD-10 CodesG47.11

G47.11

Billable

Idiopathic hypersomnia with long sleep time

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

Code Description

ICD-10 G47.11 is a billable code used to indicate a diagnosis of idiopathic hypersomnia with long sleep time.

Key Diagnostic Point:

Idiopathic hypersomnia with long sleep time is a sleep disorder characterized by excessive daytime sleepiness despite prolonged nighttime sleep. Patients typically experience prolonged sleep episodes, often exceeding 10 hours per night, and may have difficulty waking up, feeling unrefreshed even after long sleep durations. Unlike narcolepsy, individuals with idiopathic hypersomnia do not experience cataplexy or sudden sleep attacks. The etiology remains unclear, hence the term 'idiopathic.' Diagnosis often involves comprehensive sleep studies, including polysomnography, to rule out other sleep disorders such as sleep apnea. Patients may also undergo multiple sleep latency tests (MSLT) to assess their daytime sleepiness levels. Treatment options may include stimulant medications, lifestyle modifications, and behavioral therapies aimed at improving sleep hygiene. The condition can significantly impact daily functioning, leading to challenges in occupational and social settings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other sleep disorders like narcolepsy and sleep apnea
  • Need for comprehensive sleep study interpretation
  • Variability in patient presentation and symptomatology
  • Potential overlap with other ICD-10 codes related to sleep disorders

Audit Risk Factors

  • Inadequate documentation of sleep study results
  • Failure to differentiate from other sleep disorders
  • Lack of clear treatment plans in medical records
  • Insufficient patient history regarding sleep patterns

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with excessive daytime sleepiness, prolonged sleep episodes, and difficulty waking.

Billing Considerations

Ensure comprehensive documentation of sleep study findings and differentiation from other sleep disorders.

Neurology

Documentation Requirements

Neurological evaluations, sleep history, and response to treatment.

Common Clinical Scenarios

Patients with neurological conditions presenting with hypersomnia symptoms.

Billing Considerations

Document neurological assessments to rule out other causes of hypersomnia.

Coding Guidelines

Inclusion Criteria

Use G47.11 When
  • According to the ICD
  • CM coding guidelines, G47
  • 11 should be used when the diagnosis of idiopathic hypersomnia with long sleep time is confirmed through clinical evaluation and sleep study results
  • It is essential to document the duration of sleep episodes and the impact on daily functioning

Exclusion Criteria

Do NOT use G47.11 When
  • Exclusion criteria include other sleep disorders that may explain the symptoms

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

Used to diagnose sleep disorders including idiopathic hypersomnia.

Documentation Requirements

Complete sleep study report and interpretation.

Specialty Considerations

Sleep medicine specialists should ensure thorough documentation 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 idiopathic hypersomnia. This specificity aids in better tracking of prevalence and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including idiopathic hypersomnia. This specificity aids in better tracking of prevalence and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including idiopathic hypersomnia. This specificity aids in better tracking of prevalence and treatment outcomes.

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 idiopathic hypersomnia and narcolepsy?

The primary difference is that narcolepsy is characterized by sudden sleep attacks and cataplexy, while idiopathic hypersomnia involves prolonged sleep without these features.