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ICD-10 Guide
ICD-10 CodesG47.3

G47.3

Billable

Sleep apnea

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

Code Description

ICD-10 G47.3 is a billable code used to indicate a diagnosis of sleep apnea.

Key Diagnostic Point:

Sleep apnea is a sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions can last from a few seconds to minutes and may occur 30 times or more an hour. The most common type is obstructive sleep apnea (OSA), which occurs when the throat muscles intermittently relax and block the airway during sleep. Central sleep apnea (CSA) is less common and occurs when the brain fails to send appropriate signals to the muscles that control breathing. Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, is a combination of OSA and CSA. Symptoms of sleep apnea include loud snoring, episodes of breathing cessation during sleep, abrupt awakenings accompanied by gasping or choking, excessive daytime sleepiness, and difficulty concentrating. Diagnosis typically involves a sleep study (polysomnography) to monitor breathing patterns, oxygen levels, and other physiological parameters during sleep. Treatment options may include lifestyle changes, continuous positive airway pressure (CPAP) therapy, oral appliances, or surgery, depending on the severity and type of sleep apnea.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between obstructive and central sleep apnea
  • Need for comprehensive sleep study results for accurate coding
  • Potential for co-morbid conditions affecting coding
  • Variability in symptoms and severity among patients

Audit Risk Factors

  • Inadequate documentation of sleep study results
  • Failure to specify the type of sleep apnea
  • Lack of evidence for treatment compliance
  • Misinterpretation of symptoms leading to incorrect coding

Specialty Focus

Medical Specialties

Pulmonology

Documentation Requirements

Detailed sleep study results, treatment plans, and follow-up notes.

Common Clinical Scenarios

Patients presenting with excessive daytime sleepiness, loud snoring, or observed apneas.

Billing Considerations

Ensure clear documentation of the type of sleep apnea and any co-morbid conditions.

Sleep Medicine

Documentation Requirements

Comprehensive polysomnography reports and clinical evaluations.

Common Clinical Scenarios

Patients referred for sleep studies due to suspected sleep apnea.

Billing Considerations

Accurate interpretation of sleep study data is crucial for proper coding.

Coding Guidelines

Inclusion Criteria

Use G47.3 When
  • 10 coding guidelines for G47
  • 3 include the need to specify the type of sleep apnea when applicable
  • Documentation must support the diagnosis, including results from polysomnography and any associated symptoms

Exclusion Criteria

Do NOT use G47.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

Used for diagnosing sleep apnea.

Documentation Requirements

Complete sleep study report and interpretation.

Specialty Considerations

Ensure the report includes all relevant data for accurate coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of sleep apnea, enabling better tracking of the condition and its treatment. This specificity helps in understanding the prevalence and management of sleep apnea in various populations.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sleep apnea, enabling better tracking of the condition and its treatment. This specificity helps in understanding the prevalence and management of sleep apnea in various populations.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sleep apnea, enabling better tracking of the condition and its treatment. This specificity helps in understanding the prevalence and management of sleep apnea in various populations.

Resources

Clinical References

  • •
    American Academy of Sleep Medicine

Coding & Billing References

  • •
    American Academy of Sleep Medicine

Frequently Asked Questions

What is the difference between obstructive and central sleep apnea?

Obstructive sleep apnea is caused by a physical blockage of the airway, while central sleep apnea occurs when the brain fails to send signals to the muscles that control breathing. Both conditions can lead to similar symptoms but require different treatment approaches.