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ICD-10 Guide
ICD-10 CodesG47.419

G47.419

Billable

Narcolepsy without cataplexy

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

Code Description

ICD-10 G47.419 is a billable code used to indicate a diagnosis of narcolepsy without cataplexy.

Key Diagnostic Point:

Narcolepsy without cataplexy is a chronic neurological disorder characterized by excessive daytime sleepiness and sudden sleep attacks that occur at inappropriate times. Unlike narcolepsy with cataplexy, individuals with this condition do not experience sudden muscle weakness triggered by strong emotions. The disorder is believed to be caused by a deficiency of hypocretin (orexin), a neurotransmitter that regulates wakefulness and arousal. Patients may also experience disrupted nighttime sleep, hypnagogic hallucinations, and sleep paralysis. Diagnosis typically involves a thorough clinical history, sleep studies (polysomnography), and the Multiple Sleep Latency Test (MSLT) to assess the degree of daytime sleepiness and the presence of sleep onset REM periods. Treatment options include lifestyle modifications, stimulant medications, and sodium oxybate to manage symptoms and improve quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between narcolepsy with and without cataplexy
  • Need for comprehensive sleep study interpretation
  • Potential overlap with other sleep disorders like sleep apnea
  • Documentation of symptoms and their impact on daily functioning

Audit Risk Factors

  • Inadequate documentation of symptoms and their duration
  • Failure to document sleep study results
  • Misclassification of narcolepsy type
  • Lack of evidence for treatment effectiveness

Specialty Focus

Medical Specialties

Sleep Medicine

Documentation Requirements

Detailed sleep history, results from polysomnography, and MSLT findings.

Common Clinical Scenarios

Patients presenting with excessive daytime sleepiness, disrupted sleep patterns, and potential misdiagnosis with other sleep disorders.

Billing Considerations

Ensure clear differentiation between narcolepsy types and document all relevant symptoms.

Neurology

Documentation Requirements

Neurological examination findings, history of symptoms, and response to treatment.

Common Clinical Scenarios

Patients with neurological symptoms that may overlap with sleep disorders, requiring careful evaluation.

Billing Considerations

Document neurological assessments and any comorbid conditions that may affect sleep.

Coding Guidelines

Inclusion Criteria

Use G47.419 When
  • According to ICD
  • 10 guidelines, G47
  • 419 should be used when narcolepsy is diagnosed without cataplexy
  • It is essential to document the absence of cataplexy and any relevant sleep study results

Exclusion Criteria

Do NOT use G47.419 When
  • Exclusion criteria include other sleep disorders that may mimic symptoms

Related ICD-10 Codes

Related CPT Codes

95810CPT Code

Polysomnography, sleep study

Clinical Scenario

Used to diagnose narcolepsy and assess sleep architecture.

Documentation Requirements

Complete sleep study report and interpretation.

Specialty Considerations

Sleep specialists must ensure all relevant data is captured.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of narcolepsy types, improving the accuracy of diagnoses and treatment plans. G47.419 provides a clear distinction for narcolepsy without cataplexy, enhancing data collection and research opportunities.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of narcolepsy types, improving the accuracy of diagnoses and treatment plans. G47.419 provides a clear distinction for narcolepsy without cataplexy, enhancing data collection and research opportunities.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of narcolepsy types, improving the accuracy of diagnoses and treatment plans. G47.419 provides a clear distinction for narcolepsy without cataplexy, enhancing data collection and research opportunities.

Resources

Clinical References

  • •
    American Academy of Sleep Medicine

Coding & Billing References

  • •
    American Academy of Sleep Medicine

Frequently Asked Questions

What is the difference between narcolepsy with and without cataplexy?

Narcolepsy with cataplexy includes episodes of sudden muscle weakness triggered by emotions, while narcolepsy without cataplexy does not involve these episodes but still presents with excessive daytime sleepiness and other symptoms.