DSM-IV-TR Coding Alert

New Diagnostic Codes for Sleep Disorders
Effective October 1, 2005 

Prepared by Michael B. First, M.D., DSM Consultant to the American Psychiatric Institute for Research and Education (APIRE), a subsidiary of the American Psychiatric Association

Why the Changes?

Several of the diagnostic codes for the Sleep Disorders will change, effective October 1, 2005 . To meet HIPAA requirements for diagnostic code submissions to Medicare, Medicaid, and other insurance programs, all of the diagnostic codes included in DSM-IV-TR are taken from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM), which is updated yearly. A number of new diagnostic codes for sleep disorders were requested by the American Academy of Sleep Medicine, corresponding to the recent release of the 2nd Edition of the International Classification of Sleep Disorders (ICSD-2). Because of the overlap between the ICSD-2 and the Sleep Disorders section of DSM-IV-TR, these newly assigned codes have made a number of the DSM-IV-TR codes obsolete, requiring that new codes be assigned to several of the DSM-IV-TR Sleep Disorders.

What Are the Changes?

New codes are available for the following DSM-IV-TR Sleep Disorders:

327.02

Insomnia Related to … [Indicate the Axis I or Axis II Disorder]

These relatively common disorders previously shared their codes with Primary Insomnia and Primary Hypersomnia, respectively. Each now has its own unique code.

327.15

Hypersomnia Related to … [Indicate the Axis I or Axis II Disorder]

327.3x

.31

Delayed Sleep Phase Type

These new codes reflect the shifting of Circadian Rhythm Sleep Disorders from the Mental Disorders section of ICD-9-CM to the Neurological section, which houses the other varieties of Circadian Rhythm Sleep disturbances such as free-running type. Note also that each subtype now has its own diagnostic code.

.35

Jet Lag Type

.36

Shift Work Type

.30

Unspecified Type

780.57

Breathing-Related Sleep Disorder

This nonspecific code was changed due to a revision of the general symptom codes for sleep disturbances. Note that a number of more specific codes for the various types of sleep apnea are newly available in ICD-9-CM (e.g., 327.25 congenital alveolar hypoventilation syndrome) and should be coded on Axis III if applicable.

327.xx

.01

Insomnia Type

These new coding assignments reflect the expansion of the nonpsychiatric sleep disorders section in ICD-9-CM.

.14

Hypersomnia Type

.44

Parasomnia Type

.8

Mixed Type

Substance-Induced Sleep Disorders

291.82

Alcohol-Induced Sleep Disorder

Substance-Induced Sleep Disorders previously did not have unique codes, sharing their codes with Substance Intoxication, Substance-Induced Anxiety Disorders, and Substance-Induced Sexual Dysfunction. In keeping with ICD-9-CM conventions of coding alcohol differently than other substances, Alcohol-Induced Sleep Disorder now has a unique code of 291.82 and Sleep Disorder caused by other substance use has a code of 292.85.

292.85

Amphetamine-Induced Sleep Disorder

292.85

Caffeine-Induced Sleep Disorder

292.85

Cocaine-Induced Sleep Disorder

292.85

Opioid-Induced Sleep Disorder

292.85

Sedative-, Hypnotic-, or Anxiolytic-Induced Sleep Disorder

292.85

Other (or Unknown) Substance–Induced Sleep Disorder

Other Changes

The general medical code for chronic renal failure has changed from 585 to 585.9.

DSM-IV-TR includes Appendix G , “ICD-9-CM Codes for Selected General Medical Conditions,” to assist clinicians in finding the ICD-9-CM codes for selected general medical conditions that are most relevant to diagnosis and care in mental health settings. Yearly ICD-9-CM coding updates sometimes make ICD-9-CM codes in Appendix G obsolete. The ICD-9-CM codes for chronic renal failure have been expanded to include a mandatory additional fourth digit to allow for greater specificity (i.e., 585.1–585.5 for renal disease stages I–V and 585.6 for end-stage renal disease). The new code provided in Appendix G (585.9) is for “chronic renal failure unspecified,” in keeping with the DSM-IV-TR convention of using the least specific code in Appendix G.

What You Can Do to Stay Up to Date

• New printings of DSM-IV-TR will be updated to include all of the revised diagnostic codes.
• You can modify your own copy of DSM-IV-TR to reflect the coding changes. Click here for a table containing a page-by-page list of all of the diagnostic coding changes in both the text version of the DSM-IV-TR as well as the smaller Desk Reference to the DSM-IV-TR, which contains only the diagnostic criteria sets.
• Alternatively, you can download PDF files of all of the corrected pages which you can download, print, and insert into your copy of DSM-IV-TR. Click here to download the PDF files for the text version of DSM-IV-TR and here to download the PDF files for the Desk Reference to DSM-IV-TR, which contains only the diagnostic criteria sets.

• The full-text version of DSM-IV-TR available by subscription at www.psychiatryonline.com is updated to reflect new codes as they become effective.

SUMMARY OF CODE CHANGES TO DSM-IV-TR
Effective October 1, 2005

Disorder

Old Code

New Code

Alcohol-Induced Sleep Disorder

291.89

291.82

Amphetamine-Induced Sleep disorder

292.89

292.85

Caffeine-Induced Sleep disorder

292.89

292.85

Cocaine-Induced Sleep disorder

292.89

292.85

Opioid-Induced Sleep disorder

292.89

292.85

Sedative-, Hypnotic-, or Anxiolytic-Induced Sleep Disorder

292.89

292.85

Other (or Unknown) Substance–Induced
Sleep Disorder

292.89

292.85

Breathing-Related Sleep Disorder

780.59

780.57

Circadian Rhythm Sleep Disorders

307.45

Code based on below subtype

Delayed Sleep Phase Type

No code for subtype

327.31

Jet Lag Type

No code for subtype

327.35

Shift Work Type

No code for subtype

327.36

Unspecified Type

No code for subtype

327.30

Insomnia Related to … [Indicate the Axis I or Axis II Disorder]

307.42

327.02

Hypersomnia Related to … [Indicate the Axis I or Axis II Disorder]

307.44

327.15

Sleep Disorder Due to … [Indicate the General Medical Condition]

Code based on below subtype

Code based on below subtype

Insomnia Type

780.52

327.01

Hypersomnia Type

780.54

327.14

Parasomnia Type

780.59

327.44

Mixed Type

780.59

327.8

Failure, Renal, Chronic (ICD-9-CM code in Appendix G)

585

585.9*

*Greater specificity is available; see ICD-9-CM tabular listings.