icd 10 code for insomnia F51.02, F51.01

Surgical Treatment of Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) 

Uvulopalatopharyngoplasty (UPPP) may be considered medically necessary for the treatment of clinically significant obstructive sleep apnea syndrome (OSA) in appropriately selected adult patients who have not responded to or do not tolerate nasal continuous positive airway pressure (CPAP). Clinically significant OSA in this case is defined as those patients who have:

• Apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) greater than or equal to 15 events per hour, or

• AHI or RDI greater than or equal to 5 events and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

Hyoid suspension, surgical modification of the tongue, and/or maxillofacial surgery, including mandibular-maxillary advancement (MMA), may be considered medically necessary in appropriately selected adult patients with clinically significant OSA and objective documentation of hypopharyngeal obstruction who have not responded to or do not tolerate CPAP. Clinically significant OSA in this case is defined as those patients who have:

• AHI or RDI greater than or equal to 15 events per hour, or

• AHI or RDI greater than or equal to 5 events and less than or equal to 14 events per hour with documented symptoms of excessive daytime sleepiness, impaired cognition, mood disorders or insomnia, or documented hypertension, ischemic heart disease, or history of stroke.

CPAP (E0601) may be considered medically necessary for:

• Patients in whom polysomnography has documented sleep disordered breathing, with an RDI (respiratory disturbance index) of greater than fifteen, or

• Patients in whom polysomnography has documented sleep disordered breathing, with an RDI (respiratory disturbance index) of greater than five and any of the following associated symptoms:

Excessive daytime sleepiness

Impaired cognition

Mood disorders

Insomnia

Documented hypertension

Ischemic heart disease

History of stroke

• Patients who do not have sleep apnea, but who have restrictive lung disease and documented desaturation at night, requiring nocturnal ventilation

• Under individual consideration APAP may be allowed in selective patients in lieu of repeated CPAP titration when the attending sleep center physician indicates that, in his/her opinion the member would be a suitable candidate for this approach based upon member’s knowledge, behavior, and health status.

Diagnosis of OSA with abnormal Apnea Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI)

1. AHI or RDI =15; Or

2. AHI or RDI between 5 and 14 (requires one)

a. Excessive daytime sleepiness (ESS)

b. Impaired cognition

c. Insomnia

d. Mood disorder

e. Hypertension;

MSLT is considered not medically necessary in the following four situations:

• When performed for routine diagnosis of obstructive sleep apnea; OR

• For routine follow-up after treatment of sleep related disorders; OR

• For evaluation of sleepiness in medical or neurological disorders (other than narcolepsy or idiopathic hypersomnia), including, but not limited to, insomnia,
circadian rhythm disorders, and Shift Work Sleep Disorder (SWSD); OR

• Portable MSLT performed in the home setting.


ICD-10 DiagnosisCode ICD-10 Diagnosis Description

F40.241 Acrophobia

F43.0 Acute stress reaction

F43.22 Adjustment disorder with anxiety

F43.21 Adjustment disorder with depressed mood

F43.24 Adjustment disorder with disturbance of conduct

F43.23 Adjustment disorder with mixed anxiety and depressed mood

F43.25 Adjustment disorder with mixed disturbance of emotions and conduct

F43.29 Adjustment disorder with other symptoms

F43.20 Adjustment disorder, unspecified

F51.01 Primary insomnia

F51.02 Adjustment insomnia

F51.03 Paradoxical insomnia

F51.04 Psychophysiologic insomnia

F51.05 Insomnia due to other mental disorder

F51.09 Other insomnia not due to a substance of known physiological condition

F98.5 Adult onset fluency disorder

F40.01 Agoraphobia with panic disorder

F40.02 Agoraphobia without panic disorder

F40.00 Agoraphobia, unspecified

F10.180 Alcohol abuse with alcohol-induced anxiety disorder

F10.14 Alcohol abuse with alcohol-induced mood disorder

F10.150 Alcohol abuse with alcohol-induced psychotic disorder with delusions

F10.151 Alcohol abuse with alcohol-induced psychotic disorder with hallucinations

F10.159 Alcohol abuse with alcohol-induced psychotic disorder, unspecified

F10.181 Alcohol abuse with alcohol-induced sexual dysfunction

F10.182 Alcohol abuse with alcohol-induced sleep disorder

F10.121 Alcohol abuse with intoxication delirium

F10.188 Alcohol abuse with other alcohol-induced disorder

F10.19 Alcohol abuse with unspecified alcohol-induced disorder

F10.280 Alcohol dependence with alcohol-induced anxiety disorder

F10.24 Alcohol dependence with alcohol-induced mood disorder

F10.26 Alcohol dependence with alcohol-induced persisting amnestic disorder

F10.27 Alcohol dependence with alcohol-induced persisting dementia

F10.250 Alcohol dependence with alcohol-induced psychotic disorder with delusions

F10.251 Alcohol dependence with alcohol-induced psychotic disorder with hallucinations

F10.259 Alcohol dependence with alcohol-induced psychotic disorder, unspecified

F10.281 Alcohol dependence with alcohol-induced sexual dysfunction

F10.282 Alcohol dependence with alcohol-induced sleep disorder

F10.221 Alcohol dependence with intoxication delirium

F10.288 Alcohol dependence with other alcohol-induced disorder

F10.29 Alcohol dependence with unspecified alcohol-induced disorder

F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations

F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified

F18.921 Inhalant use, unspecified with intoxication with delirium

F51.05 Insomnia due to other mental disorder

F51.12 Insufficient sleep syndrome

F63.81 Intermittent explosive disorder

F63.2 Kleptomania

F33.2 Major depressive disorder, recurrent severe without psychotic features

F33.42 Major depressive disorder, recurrent, in full remission

F33.41 Major depressive disorder, recurrent, in partial remission

F33.40 Major depressive disorder, recurrent, in remission, unspecified

F33.0 Major depressive disorder, recurrent, mild

F33.1 Major depressive disorder, recurrent, moderate

F33.3 Major depressive disorder, recurrent, severe with psychotic symptoms

F33.9 Major depressive disorder, recurrent, unspecified

F32.5 Major depressive disorder, single episode, in full remission

F32.4 Major depressive disorder, single episode, in partial remission

F32.0 Major depressive disorder, single episode, mild

F32.1 Major depressive disorder, single episode, moderate

F32.3 Major depressive disorder, single episode, severe with psychotic features

F32.2 Major depressive disorder, single episode, severe without psychotic features

F32.9 Major depressive disorder, single episode, unspecified

F52.21 Male erectile disorder

F52.32 Male orgasmic disorder

F30.4 Manic episode in full remission

F30.3 Manic episode in partial remission

F30.11 Manic episode without psychotic symptoms, mild

F30.12 Manic episode without psychotic symptoms, moderate

F30.10 Manic episode without psychotic symptoms, unspecified

F30.2 Manic episode, severe with psychotic symptoms

F30.13 Manic episode, severe, without psychotic symptoms

F30.9 Manic episode, unspecified

F42.2 Mixed obsessional thoughts and acts

F06.31 Mood disorder due to known physiological condition with depressive features

F06.32 Mood disorder due to known physiological condition with major depressive-like episode

F06.33 Mood disorder due to known physiological condition with manic features

F06.34 Mood disorder due to known physiological condition with mixed features

F06.30 Mood disorder due to known physiological condition, unspecified

F91.8 Other conduct disorders

F32.8 Other depressive episodes

F80.89 Other developmental disorders of speech and language

F88 Other disorders of psychological development

F50.8 Other eating disorders

F98.29 Other feeding disorders of infancy and early childhood

F64.8 Other gender identity disorders

F45.29 Other hypochondriacal disorders

F63.8 Other impulse disorders

F51.09 Other insomnia not due to a substance or known physiological condition

F42.8 Other obsessive compulsive disorder

F30.8 Other manic episodes

F41.3 Other mixed anxiety disorders

F40.228 Other natural environment type phobia

F65.89 Other paraphilias

F34.8 Other persistent mood ºaffective» disorders

F07.89 Other personality and behavioral disorders due to known physiological condition

F84.8 Other pervasive developmental disorders

F40.8 Other phobic anxiety disorders

F19.121 Other psychoactive substance abuse with intoxication delirium

F19.122 Other psychoactive substance abuse with intoxication with perceptual disturbances

F19.188 Other psychoactive substance abuse with other psychoactive substance-induced disorder

F19.180 Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder

F19.14 Other psychoactive substance abuse with psychoactive substance-induced mood disorder

F19.16 Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder

F19.17 Other psychoactive substance abuse with psychoactive substance-induced persisting dementia

F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delus

F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallu

F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecifi

F19.181 Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction

F19.182 Other psychoactive substance abuse with psychoactive substance-induced sleep disorder

F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified

F15.181 Other stimulant abuse with stimulant-induced sexual dysfunction

F15.182 Other stimulant abuse with stimulant-induced sleep disorder

F15.19 Other stimulant abuse with unspecified stimulant-induced disorder

F15.221 Other stimulant dependence with intoxication delirium

F15.222 Other stimulant dependence with intoxication with perceptual disturbance

F15.288 Other stimulant dependence with other stimulant-induced disorder

F15.280 Other stimulant dependence with stimulant-induced anxiety disorder

F15.24 Other stimulant dependence with stimulant-induced mood disorder

F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions

F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations

F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified

F15.281 Other stimulant dependence with stimulant-induced sexual dysfunction

F15.282 Other stimulant dependence with stimulant-induced sleep disorder

F15.29 Other stimulant dependence with unspecified stimulant-induced disorder

F15.921 Other stimulant use, unspecified with intoxication delirium

F15.922 Other stimulant use, unspecified with intoxication with perceptual disturbance

F15.988 Other stimulant use, unspecified with other stimulant-induced disorder

F15.980 Other stimulant use, unspecified with stimulant-induced anxiety disorder

F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder

F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions

F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations

F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified

F15.981 Other stimulant use, unspecified with stimulant-induced sexual dysfunction

F15.982 Other stimulant use, unspecified with stimulant-induced sleep disorder

F95.8 Other tic disorders

F45.41 Pain disorder exclusively related to psychological factors

F45.42 Pain disorder with related psychological factors

F41.0 Panic disorder ºepisodic paroxysmal anxiety» without agoraphobia

F51.03 Paradoxical insomnia

F60.0 Paranoid personality disorder

F20.0 Paranoid schizophrenia

F65.9 Paraphilia, unspecified

F63.0 Pathological gambling

F65.4 Pedophilia

F34.9 Persistent mood ºaffective» disorder, unspecified

F07.0 Personality change due to known physiological condition

F60.9 Personality disorder, unspecified

F84.9 Pervasive developmental disorder, unspecified

F40.9 Phobic anxiety disorder, unspecified

F98.3 Pica of infancy and childhood

F43.11 Post-traumatic stress disorder, acute

F43.12 Post-traumatic stress disorder, chronic

F43.10 Post-traumatic stress disorder, unspecified

F07.81 Postconcussional syndrome

F52.4 Premature ejaculation

F32.81 Premenstrual dysphonic disorder

F51.11 Primary hypersomnia

F51.01 Primary insomnia

F48.2 Pseudobulbar affect

F06.2 Psychotic disorder with delusions due to known physiological condition

F06.0 Psychotic disorder with hallucinations due to known physiological condition

F53 Puerperal psychosis

F63.1 Pyromania

F43.9 Reaction to severe stress, unspecified

F94.1 Reactive attachment disorder of childhood

F20.5 Residual schizophrenia

F98.21 Rumination disorder of infancy

F65.50 Sadomasochism, unspecified

F25.0 Schizoaffective disorder, bipolar type

F25.1 Schizoaffective disorder, depressive type

F25.9 Schizoaffective disorder, unspecified

F60.1 Schizoid personality disorder

F20.9 Schizophrenia, unspecified

F20.81 Schizophreniform disorder

F21 Schizotypal disorder

F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium

F13.188 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolyticinduced disorder

F13.180 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolyticinduced anxiety disorde

F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolyticinduced mood disorder

F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolyticinduced psychotic disor