2006 ICD-9 Update Modules

2006 ICD-9 codes - 6 of 7

2006 introduces new sleep disorder codes as well as organic, sleep-disorder codes.

327.40* Organic Parasomnia, unspecified.

Parasomnias are a group of conditions that represent undesirable or unpleasant occurrences during sleep. Behavior during these times can often lead to damage to the surroundings and injury to the patient or to others.

Parasomnia may include:

Sleepwalking
Sleep terrors
REM sleep behavior disorders.

In many of these cases, the nature of these conditions may be established by careful clinical evaluation. Suspected seizure disorders as possible causes of the parasomnia are appropriately evaluated by standard or prolonged sleep EEG studies.

In cases where seizure disorders have been ruled out and in cases that present a history of repeated violent or injurious episodes during sleep, polysomnography may be useful in providing a diagnostic classification or prognosis.

Use HCPCS procedure codes 95808, 95810 or 95811 to report these tests.

http://www.iamedicare.com/provider/policy/draft/DL2579.htm

LCD for Polysomnography Sleep Testing (DL2579) (link above)

http://www.medcare.com/professionals/reimbursement/

Reimbursement issues for sleep testing. (above)

More sleep disorder codes.

327.41* Confusional arousals
327.42* REM sleep behavior disorder
327.43* Recurrent isolated sleep paralysis
327.44* Parasomnia in conditions classified elsewhere
327.49* Other organic parasomnia
327.51* Periodic limb movement disorder
327.52* Sleep related leg cramps

REM is the acronym for Rapid Eye Movement, the periodic jerky movement of the eyes during certain stages of the sleep cycle when dreaming takes place.

327.53* Sleep related bruxism involves the grinding or clenching of teeth during sleep.

Two "other" codes complete the new, organic, sleep-related disorders section.

327.59* Other organic sleep related movement disorders
327.8* Other organic sleep disorders

The coder should explain to the provider the reimbursement implications of an organic versus psychogenic disorders. Of course, the diagnosis should never be determined by reimbursement. Reporting organic diseases in order to be reimbursed when the problem is actually psychological would be considered fraud.

However, if a primary care provider feels that the problem is mostly psychological, it is best to report symptoms and refer the patient to a mental health professional.

New diabetic retinopathy codes. Code diabetes with ophthalmic manifestations 250.5x. Always code diabetes first and the manifestation second.

362.03 Nonproliferative diabetic retinopathy NOS
362.04 Mild nonproliferative diabetic retinopathy
362.05 Moderate nonproliferative diabetic retinopathy
362.06 Severe nonproliferative diabetic retinopathy
362.07 Diabetic macular edema

Diabetic retinopathy is defined as retinal changes occurring in long-term diabetes and characterized by punctate hemorrhages, microaneurysms, and sharply defined waxy exudates.

Diabetic retinopathy is retinopathy (damage to the retina) caused by complications of diabetes mellitus, which could eventually lead to blindness. It is an ocular manifestation of systemic disease which affects up to 80% of all diabetics who have had diabetes for 15 years or more.

Diabetic macular edema: Swelling of the retina in diabetes mellitus due to leaking of fluid from blood vessels within the macula. The macula is the central portion of the retina, a small area rich in cones, the specialized nerve endings that detect color and upon which daytime vision depends.