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ICD-10 Guide
ICD-10 CodesF51.11

F51.11

Billable

Primary hypersomnia

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

Code Description

ICD-10 F51.11 is a billable code used to indicate a diagnosis of primary hypersomnia.

Key Diagnostic Point:

Primary hypersomnia is a sleep disorder characterized by excessive daytime sleepiness that is not attributable to other sleep disorders, medical conditions, or psychiatric disorders. Patients with primary hypersomnia often experience prolonged nighttime sleep but still feel excessively sleepy during the day. This condition can significantly impair daily functioning, affecting work, social interactions, and overall quality of life. The etiology of primary hypersomnia is not fully understood, but it may involve genetic, neurobiological, and environmental factors. Diagnosis typically requires a thorough clinical evaluation, including sleep history, sleep studies, and ruling out other potential causes of hypersomnia. Treatment options may include lifestyle modifications, stimulant medications, and behavioral therapies. It is essential for healthcare providers to differentiate primary hypersomnia from other sleep disorders, such as narcolepsy or sleep apnea, to ensure appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other sleep disorders like narcolepsy and sleep apnea.
  • Need for comprehensive sleep history and possible polysomnography.
  • Potential overlap with psychiatric conditions such as depression.
  • Variability in patient presentation and symptom severity.

Audit Risk Factors

  • Inadequate documentation of sleep history.
  • Failure to perform or document sleep studies.
  • Misdiagnosis due to overlapping symptoms with other conditions.
  • Lack of evidence for the impact of symptoms on daily functioning.

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Detailed sleep history, results from polysomnography, and documentation of daytime functioning.

Common Clinical Scenarios

Patients presenting with excessive daytime sleepiness, difficulty concentrating, and disrupted sleep patterns.

Billing Considerations

Ensure comprehensive evaluation to rule out other sleep disorders and document the impact on quality of life.

Psychiatry

Documentation Requirements

Assessment of mood disorders, sleep patterns, and any co-occurring psychiatric conditions.

Common Clinical Scenarios

Patients with primary hypersomnia presenting with depressive symptoms or anxiety.

Billing Considerations

Consider the interplay between mood disorders and sleep disorders in treatment planning.

Coding Guidelines

Inclusion Criteria

Use F51.11 When
  • According to ICD
  • 10 guidelines, primary hypersomnia should be coded when excessive daytime sleepiness is the primary complaint and other sleep disorders have been ruled out
  • Documentation must support the diagnosis and include the impact on daily functioning

Exclusion Criteria

Do NOT use F51.11 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

Used to evaluate patients with suspected primary hypersomnia.

Documentation Requirements

Document the indication for the sleep study and results.

Specialty Considerations

Sleep specialists should ensure comprehensive evaluation and interpretation 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 sleep disorders, including primary hypersomnia, which aids in better tracking and management of these conditions. It has improved the granularity of data for research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including primary hypersomnia, which aids in better tracking and management of these conditions. It has improved the granularity of data for research and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including primary hypersomnia, which aids in better tracking and management of these conditions. It has improved the granularity of data for research 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 difference between primary hypersomnia and narcolepsy?

Primary hypersomnia is characterized by excessive daytime sleepiness without the presence of cataplexy or other symptoms typical of narcolepsy. Narcolepsy includes sudden sleep attacks and may involve cataplexy, which is not seen in primary hypersomnia.