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v1.0.0
ICD-10 Guide
ICD-10 CodesR06.3

R06.3

Periodic breathing

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R06.3 is a billable code used to indicate a diagnosis of periodic breathing.

Key Diagnostic Point:

Periodic breathing is characterized by alternating periods of hyperventilation and hypoventilation, often leading to episodes of apnea. This phenomenon can occur in various clinical contexts, including sleep disorders, neurological conditions, and metabolic disturbances. It is commonly observed in infants, particularly during sleep, but can also manifest in adults with underlying health issues. The clinical significance of periodic breathing varies; in some cases, it may be benign, while in others, it can indicate serious underlying pathology such as central nervous system disorders or respiratory failure. Diagnosis typically involves clinical observation, polysomnography, and assessment of arterial blood gases to evaluate the severity and implications of the breathing pattern. Understanding the context in which periodic breathing occurs is crucial for appropriate management and intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation across different age groups
  • Potential overlap with other respiratory conditions
  • Need for comprehensive clinical context for accurate coding
  • Differentiation from other abnormal breathing patterns

Audit Risk Factors

  • Inadequate documentation of the clinical context
  • Failure to specify associated symptoms or conditions
  • Misclassification with other respiratory disorders
  • Lack of clear diagnostic criteria in the medical record

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed patient history, including respiratory symptoms, neurological status, and any relevant lab findings.

Common Clinical Scenarios

Patients presenting with unexplained shortness of breath, especially in the context of chronic illness or sleep disturbances.

Billing Considerations

Ensure to document any comorbidities that may contribute to periodic breathing.

Emergency Medicine

Documentation Requirements

Acute assessment of respiratory status, vital signs, and immediate interventions taken.

Common Clinical Scenarios

Patients with acute respiratory distress or altered mental status presenting to the emergency department.

Billing Considerations

Rapid documentation of findings is crucial, especially in life-threatening situations.

Coding Guidelines

Inclusion Criteria

Use R06.3 When
  • Follow the official ICD
  • CM guidelines for coding symptoms and signs
  • Ensure that the code is supported by clinical documentation that specifies the nature of the periodic breathing and any associated conditions

Exclusion Criteria

Do NOT use R06.3 When
No specific exclusions found.

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

When periodic breathing is suspected, a sleep study may be ordered.

Documentation Requirements

Document the indication for the sleep study and any relevant findings.

Specialty Considerations

Sleep medicine specialists should ensure comprehensive reporting of sleep study results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of symptoms like periodic breathing, improving the granularity of data collected for research and clinical management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of symptoms like periodic breathing, improving the granularity of data collected for research and clinical management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of symptoms like periodic breathing, improving the granularity of data collected for research and clinical management.

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 clinical significance of periodic breathing?

Periodic breathing can indicate underlying health issues, particularly in patients with neurological or respiratory conditions. It requires careful evaluation to determine the need for intervention.