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ICD-10 Guide
ICD-10 CodesF51.19

F51.19

Billable

Other hypersomnia not due to a substance or known physiological condition

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

Code Description

ICD-10 F51.19 is a billable code used to indicate a diagnosis of other hypersomnia not due to a substance or known physiological condition.

Key Diagnostic Point:

F51.19 refers to a category of sleep disorders characterized by excessive daytime sleepiness that is not attributable to substance use or any identifiable physiological condition. This condition can manifest in various forms, including prolonged sleep episodes, difficulty waking up, and persistent fatigue despite adequate sleep duration. It is essential to differentiate this condition from other sleep disorders such as narcolepsy or sleep apnea, which have distinct etiologies. Patients may experience significant impairment in daily functioning, affecting their work, social interactions, and overall quality of life. The diagnosis often requires a comprehensive evaluation, including sleep history, polysomnography, and ruling out other medical or psychiatric conditions. Treatment may involve behavioral interventions, lifestyle modifications, and in some cases, pharmacotherapy. Understanding the nuances of this condition is crucial for accurate coding and effective management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other sleep disorders like narcolepsy and sleep apnea.
  • Need for comprehensive patient history and evaluation.
  • Potential overlap with psychiatric conditions such as depression or anxiety.
  • Variability in patient presentation and symptomatology.

Audit Risk Factors

  • Inadequate documentation of sleep history.
  • Failure to rule out other sleep disorders.
  • Insufficient evidence of non-substance-related causes.
  • Lack of comprehensive treatment plans.

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Detailed sleep history, results from polysomnography, and exclusion of other sleep disorders.

Common Clinical Scenarios

Patients presenting with excessive daytime sleepiness without identifiable causes.

Billing Considerations

Consideration of comorbid psychiatric conditions and their impact on sleep.

Psychiatry

Documentation Requirements

Assessment of mood disorders, anxiety levels, and their relationship to sleep patterns.

Common Clinical Scenarios

Patients with hypersomnia presenting alongside depressive symptoms.

Billing Considerations

Need to differentiate between primary hypersomnia and hypersomnia secondary to mood disorders.

Coding Guidelines

Inclusion Criteria

Use F51.19 When
  • According to ICD
  • 10 guidelines, F51
  • 19 should be used when hypersomnia is not attributable to substance use or a known physiological condition
  • Documentation must clearly indicate the absence of these factors

Exclusion Criteria

Do NOT use F51.19 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 sleep disorders.

Documentation Requirements

Results of the sleep study must be documented.

Specialty Considerations

Sleep specialists should interpret the 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 F51.19, which helps in better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including F51.19, which helps in better tracking and management of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of sleep disorders, including F51.19, which helps in better tracking and management of these conditions.

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 are the primary symptoms of F51.19?

Primary symptoms include excessive daytime sleepiness, prolonged sleep episodes, and difficulty waking up, without identifiable causes.

How is F51.19 diagnosed?

Diagnosis involves a thorough patient history, sleep studies, and ruling out other sleep disorders or substance use.