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ICD-10 Guide
ICD-10 CodesG47.09

G47.09

Billable

Other insomnia

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

Code Description

ICD-10 G47.09 is a billable code used to indicate a diagnosis of other insomnia.

Key Diagnostic Point:

Other insomnia encompasses various forms of sleep disturbances that do not fit into the more commonly recognized categories of insomnia, such as chronic insomnia disorder or primary insomnia. Patients may experience difficulty falling asleep, staying asleep, or waking up too early, leading to daytime fatigue and impaired functioning. This condition can be influenced by a multitude of factors including psychological stress, medical conditions, medications, and lifestyle choices. Insomnia can also be a symptom of underlying sleep disorders such as sleep apnea or narcolepsy. The diagnosis of other insomnia requires a thorough evaluation, including a detailed sleep history and possibly a sleep study, to rule out other sleep disorders. Treatment options may include cognitive-behavioral therapy for insomnia (CBT-I), lifestyle modifications, and pharmacotherapy. Accurate coding is essential for proper treatment and reimbursement, as well as for tracking the prevalence of sleep disorders in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes that can lead to insomnia.
  • Overlap with other sleep disorders, complicating diagnosis.
  • Need for comprehensive patient history and possible sleep study.
  • Variability in treatment approaches based on individual patient factors.

Audit Risk Factors

  • Inadequate documentation of sleep history.
  • Failure to rule out other sleep disorders.
  • Lack of clarity in treatment plans.
  • Inconsistent use of diagnostic criteria.

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Detailed sleep history, results from sleep studies, and treatment plans.

Common Clinical Scenarios

Patients presenting with chronic fatigue, difficulty sleeping, or suspected sleep apnea.

Billing Considerations

Documentation must include differential diagnoses and rationale for treatment choices.

Psychiatry

Documentation Requirements

Mental health evaluations, medication history, and psychosocial factors affecting sleep.

Common Clinical Scenarios

Patients with insomnia linked to anxiety, depression, or other mental health disorders.

Billing Considerations

Must document the interplay between mental health and sleep disturbances.

Coding Guidelines

Inclusion Criteria

Use G47.09 When
  • According to ICD
  • 10 guidelines, G47
  • 09 should be used when insomnia is not classified elsewhere
  • It is essential to document the specific nature of the insomnia and any contributing factors

Exclusion Criteria

Do NOT use G47.09 When
  • Exclusion criteria include insomnia due to substance use or other sleep disorders

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

Used when insomnia is suspected to be related to sleep apnea or other sleep disorders.

Documentation Requirements

Results of the sleep study must be documented, including any observed apneas or hypopneas.

Specialty Considerations

Sleep specialists should ensure comprehensive reports are generated.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of insomnia, enabling better tracking of sleep disorders and their management. G47.09 provides a distinct code for insomnia that does not fall into other categories, improving the accuracy of health records.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of insomnia, enabling better tracking of sleep disorders and their management. G47.09 provides a distinct code for insomnia that does not fall into other categories, improving the accuracy of health records.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of insomnia, enabling better tracking of sleep disorders and their management. G47.09 provides a distinct code for insomnia that does not fall into other categories, improving the accuracy of health records.

Resources

Clinical References

  • •
    American Academy of Sleep Medicine

Coding & Billing References

  • •
    American Academy of Sleep Medicine

Frequently Asked Questions

What is the difference between G47.09 and G47.00?

G47.09 is used for other types of insomnia that do not fit into the primary insomnia category (G47.00). It requires documentation of specific underlying causes or contributing factors.