ICD-10 Code for Insomnia

Touseef Riaz

August 1, 2021

ICD-10 Conde for insomnia

Getting a good night’s sleep is imperative for physical and mental health, and thus an important part of one’s daily routine. Quality sleep ensures that your body maintains critical functionality and restores the energy to begin a new day rejuvenated. Sleep deprivation can result in a range of physical and mental problems, leading to serious health conditions such as depression, diabetes, and obesity.


ICD 10 Code for Insomnia

The ICD-10 code for insomnia is G47.00 which is the billable code utilized for various purposes including healthcare diagnosis and reimbursement process. Previously, the corresponding ICD-9 code was 780.52.

Under the ICD-10 code, insomnia is designated sleep state misperception, also known as SSM. It is described as a condition when a person finds it difficult to fall asleep or continue to sleep for a period of time. The condition can drain not only energy levels and mood but also affect your health, work performance, and quality of life.

The American Psychiatric Association describes insomnia as one of the most common sleep disorders. According to a report, a staggering one-third of the adult population in the US suffers from insomnia symptoms.

Insomnia can be of two types based on duration:

Acute insomnia:  This is typically short-term and brief. Acute insomnia is mostly attributed to life circumstances and does not require any treatment to be resolved.

Chronic insomnia: Chronic insomnia is longer in duration. It is basically disrupted sleep that happens more than three nights per week and for more than three months. There are various treatments including medication, behavioral, psychological, or a combination of all three. The ICD-10 code for chronic insomnia is G47.01

reasons of insomniaa

According to a report, over 40% of the US adult population annually experience problems in sleeping and are affected by one sleep disorder or another. Sleep disorders are a group of conditions that affect the ability to sleep on a regular basis. As per the International Classification of Sleep Disorders, there are over 80 different types of sleep disorders, with insomnia being one of the most prevalent.

Despite the prevalence of sleep disorders, methodologies used for identifying such patients from administrative data are limited. That is because the process of medical coding and billing for sleep disorders is complicated, and organizations often are not able to keep up with the coding practices. Outsourcing these processes to a trustworthy medical company like UControl Billing can help you stay updated with the current billing and coding rules, ensure the payment process is smooth and everything is properly documented for use as administrative data.

Sleep Disorders and Causes

Many people experience sleeping problems occasionally caused by hectic schedules, stress, and other external factors. When these issues are left unchecked, they can start interfering with daily life and evolve into a sleep disorder.

Depending on the sleep disorder, people face issues while falling asleep. As a result, they are unable to function throughout the day, affecting their overall productivity. The lack of sleep can have a negative impact on energy, mood, concentration, and overall health. Following are some of the major sleep disorders:


Insomnia pertains to the condition where one is unable to maintain sleep. The condition does not fall under the Comorbid/Complication or Major Comorbid/Complication. However, if the condition happens due to substance dependence or abuse, then it will be a Hierarchical Condition Category.


Narcolepsy is excessive daytime sleepiness combined with sudden muscle weakness. This means that you feel extremely tired throughout the day and may fall asleep without warning. Narcolepsy usually occurs on its own but is also attributed to certain neurological disorders such as sclerosis.


Sleep apnea:

Sleep apnea is a serious medical condition where a person has trouble breathing while asleep. This happens because the body takes in less oxygen and can cause you to wake up suddenly during the night. Sleep apnea is either caused when the flow of air stops due to an obstruction in the airway or when there is a problem in the connection between the muscles that control your breath and the brain.

ICD 10 Code Set

ICD-10 (short for International Classification of Diseases, tenth edition) is a clinical documentation and cataloging system owned by the World Health organization which consists of thousands of codes, where each code represents critical information about the different diseases, findings, causes of injuries, symptoms, possible treatments, and epidemiology, playing a vital role in enabling advancements in clinical treatment and medication.

Under the Health Insurance Portability and Accountability Act (HIPAA), it is required by all healthcare providers and physicians to apply the ICD-10 codes in their practices, replacing the previous ICD-9 code set.

ICD serves as a foundation to identify clinical trends and statistics globally. Diseases, injuries, disorders, and all health conditions are listed comprehensively and organized into standard groupings allowing health care providers from around the world to compare and share information using the ICD codes.

Diagnosis and Treatment

To assist in the diagnosis of insomnia, a health physician starts by asking patients to fill out a questionnaire. The questionnaire helps provide information regarding the sleep patterns plus the medical history of the patient. Moreover, physicians may also collect information over several weeks to determine the wake-sleep routine. Blood tests and other medical tests may also be part of the diagnosis to rule out and determine the actual reason for the condition.

The treatment for insomnia does not require any medication or psychological attention as mentioned before. It can be resolved by creating good sleep habits which include:

·         Keeping consistent sleep and wake times

·         Eliminating sleep during daytime

·         Avoid heavy meals, caffeine, alcohol, and nicotine during the day

·         Regular exercise

·         Making your bedroom sleep-friendly


Sleep disorders are poorly documented and coded from inpatient data sources, which makes it difficult to identify administrative data when it comes to insomnia. This may be a function of how sleep disorders are diagnosed and/or reported by physicians in inpatient and outpatient settings within medical records. Future work to optimize administrative data case definitions through data linkage is needed.

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