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v1.0.0
ICD-10 Guide
ICD-10 CodesG47.41

G47.41

Billable

Narcolepsy

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

Code Description

ICD-10 G47.41 is a billable code used to indicate a diagnosis of narcolepsy.

Key Diagnostic Point:

Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness (EDS) and sudden sleep attacks. It is caused by the brain's inability to regulate sleep-wake cycles, often due to a deficiency of hypocretin (orexin), a neurotransmitter that promotes wakefulness. Patients may experience cataplexy, which is a sudden loss of muscle tone triggered by strong emotions, sleep paralysis, and hypnagogic hallucinations. Diagnosis typically involves a comprehensive sleep study (polysomnography) and the Multiple Sleep Latency Test (MSLT) to assess the degree of daytime sleepiness and the presence of REM sleep during naps. Narcolepsy can significantly impact daily functioning, leading to difficulties in work, education, and social interactions. Treatment options include lifestyle modifications, stimulant medications, and sodium oxybate to manage symptoms effectively. Understanding narcolepsy is crucial for healthcare providers to ensure accurate diagnosis and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other sleep disorders such as sleep apnea and idiopathic hypersomnia.
  • Need for comprehensive sleep study results for accurate diagnosis.
  • Variability in symptoms and severity among patients.
  • Potential for co-morbid conditions that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of symptoms and their impact on daily life.
  • Failure to document the results of sleep studies.
  • Misdiagnosis due to overlapping symptoms with other sleep disorders.
  • Lack of follow-up documentation to support ongoing treatment.

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Detailed sleep study results, patient history, and symptom logs.

Common Clinical Scenarios

Patients presenting with excessive daytime sleepiness and cataplexy.

Billing Considerations

Ensure clear documentation of the MSLT results and any comorbid sleep disorders.

Neurology

Documentation Requirements

Neurological assessments, patient history, and symptom descriptions.

Common Clinical Scenarios

Patients with neurological symptoms and suspected narcolepsy.

Billing Considerations

Document any neurological evaluations that support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use G47.41 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of symptoms, diagnostic tests, and treatment plans
  • Include specific details from sleep studies and patient history to support the diagnosis

Exclusion Criteria

Do NOT use G47.41 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

Used to diagnose narcolepsy through sleep study.

Documentation Requirements

Complete sleep study report and interpretation.

Specialty Considerations

Ensure the report includes details on REM sleep and sleep latency.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of narcolepsy, improving the accuracy of diagnoses and treatment plans. It has also facilitated better tracking of the condition's prevalence and management outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of narcolepsy, improving the accuracy of diagnoses and treatment plans. It has also facilitated better tracking of the condition's prevalence and management outcomes.

Reimbursement & Billing Impact

reimbursement and compliance.

Resources

Clinical References

  • •
    Narcolepsy Network

Coding & Billing References

  • •
    Narcolepsy Network

Frequently Asked Questions

What are the primary symptoms of narcolepsy?

The primary symptoms include excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucinations.

How is narcolepsy diagnosed?

Narcolepsy is diagnosed through a combination of patient history, polysomnography, and the Multiple Sleep Latency Test (MSLT).

What treatments are available for narcolepsy?

Treatment options include lifestyle changes, stimulant medications, and sodium oxybate to manage symptoms effectively.