How to Accurately Use ICD-10 Code G47.33 for Obstructive Sleep Apnea Claims?

Are you a dentist or run a dental practice that treats patients with sleep apnea? If yes, then surely you must be filing claims for insurance benefits against the treatment. It requires a medical code and you must be aware of it to get proper reimbursement.

As dentists and orthodontists are adding sleep-related services to their treatments, they need to file an accurate claim by including the right ICD-10 sleep apnea code to fulfill insurance requirements.

Dentists commonly prescribe an oral appliance for treating sleep-related conditions like obstructive sleep apnea (OSA) and snoring.

• G47.33 is the code used against Obstructive Sleep Apnea for adults and pediatrics.
• Other sleep disorders are specified using G47.8.
• Snoring is represented by R06.83.
• J98.8 is for other specified respiratory disorders.

In this blog, we will discuss ICD-10 Code G47.33 for obstructive sleep apnea in detail, like what it is, its description, commonly associated symptoms, and the instructional guidelines related to it in the ICD-10 update by the Center for Medicare and Medicaid Services (CMS).

What is the G47.33 Code?

As mentioned above, it’s an ICD-10-CM code for Obstructive Sleep Apnea for adults and pediatrics. G47.33 is part of the 10th edition of ICD-10-CM, which is a coding system used by healthcare specialists to code and classify diagnoses, symptoms, and procedures.

Description of G47.33 (Obstructive Sleep Apnea)

Abbreviated as OSA, this is concerning sleep disorder and happens when a person’s breathing interrupts sleep repeatedly. 

It happens due to obstructions in the upper respiratory system during sleep and results in breathing difficulties and decreased levels of oxygen in the blood.

Apart from sleep interruption, it can lead to other health issues like daytime fatigue, cardiovascular diseases, and even cognitive impairment.

G47.33 is the code referring to sleep apnea in the ICD-10 code, and it is used to indicate obstructive sleep apnea in grown-ups and children.

Symptoms Associated with G47.33

Some of the common symptoms of sleep apnea include:

• Loud snoring
• Breathing cessation event
• Events of choking or gasping during sleep resulting in sudden awakening
• Excessive daytime sleepiness
• Headache in the morning
• Lack of energy all day long
• Insomnia
• Forgetfulness
• Difficulty in memorizing things
• Concentrations issues
• Abrupt mood swings
• Dry mouth or sore throat

Sleep apnea and the side effects associated with it could result in obesity, premature aging, sleep disorders in the next generation, and other medical conditions like hypothyroidism and acromegaly.

ICD-10 Codes Similar to G47.33

Correct Usage of G47.33 Code for Billing

Before billing for obstructive sleep apnea, it is important for all dentists and dental surgeons to ensure proper documentation of the diagnosis in the patient’s medical record.

By proper documentation, we mean a complete diagnosis history and physical examination record. Not to forget any other related diagnostic tests like polysomnography or sleep study test.

Dental care providers are advised to use the code properly so that it reflects the patient’s clinical condition. It also helps to support in case of any medical necessity against a treatment or intervention period.

Helpful Guidelines for Dentists While Coding G47.33

• Double-check to confirm the diagnosis of obstructive sleep apnea via proper testing and criteria.
• Note down all appropriate clinical findings, such as symptoms in the patient’s health record.
• Only use G47.33 for OSA and not for any other type of sleep apnea, like primary central sleep apnea.
• Confirm and cross-check to ensure that coding is correct and according to the guidelines of the ICD-10-CM’s updates.

While coding and reporting, coding teams must always ensure to follow the guidelines of ICD-10-CM’s latest updates.

This is especially crucial when adding instructions related to obstructive sleep apnea and sleep disorders. Coders must also stay up to date with any changes or revisions to the coding guidelines.

For instance, an excludes 1 note is added at code G47.33 while referring to Pediatric Obstructive Sleep Apnea (P28.3–). This note shows that when OSA is diagnosed in a newborn, the accurate to use is (P28.3–) rather than G47.33.

The Excludes 1 note tells the coders that when coding for Pickwickian syndrome (E66.2), there’s no need to include code for sleep apnea, i.e., (G47.3). It is already a type of sleep apnea linked to obesity. Coding both would result in duplication of codes and is considered inaccurate.

The excludes 1 note tells that when Obstructive Sleep Apnea is diagnosed with Pickwickian Syndrome, the accurate code to be used is (E66.2) and not (G47.33). Also, at subcategory G47.3 (sleep apnea), an instructional code guides the coder to “code any associated underlying condition.”

This excludes note specifies that codes defined for associated conditions must be included in the diagnosis code to describe the patient’s condition completely. However, the order of the coding depends on the specific circumstances of the encounter.

Common Issues in Coding with G47.33M

• It is difficult to differentiate between Obstructive Sleep Apnea and other types of sleep apnea, which could lead to complications and inaccurate coding.
• Improper or insufficient documentation regarding diagnosis means one cannot justify the usage of the G47.33 code for billing and reimbursement purposes.
• Not taking into consideration the supporting diagnostic tests, like polysomnography, to validate the diagnosis of obstructive sleep apnea.  

Use of Sleep Apnea ICD-10 Code in Documentation

It is important to note that it is not the duty of a dentist or dental surgeon to diagnose sleep-related conditions.

However, they do play a vital role in sleep medicine, oral appliances, and other things. According to regulations, only a licensed dentist has the authority to provide and fit an oral appliance.

Such a diagnosis is added to the sleep study report along with a referral from the doctor treating the condition. Moreover, it is essential to obtain complete documentation and include it in the patient’s record. Ensure that the diagnosis of the condition is verified by the doctor treating the condition.

Another important aspect here is that it is not ethical to report a diagnosis code that helps in getting claims paid from the insurance. For instance, the coder may be instructed to use G47.33 – the ICD-10 code for sleep apnea for all sleep apnea appliance claims.

Although the usage of this code helps you get the claim paid, it is essential to ask a question, i.e., is this the correct condition from which the patient suffers? What if their diagnosis includes only snoring?

Important Tips for Dental Office

Here are some of the most crucial appliance filling claims tips for the dental office staff to remember.

• Validate the sleep-related diagnosis from the Doctor of Medicine responsible for treating the    issue before starting treatment.
• Double-check the inclusion of correct documentation in the patient’s chart.
• When applying ICD-10 sleep apnea codes on a dental/medical claim, it is important to find a dependable source for correct information.
• Social media chat rooms may not always provide you with trustworthy educational sources.
• People in dentistry need to keep in mind that a claim form is a legal document with immense importance to start with and going forward.
• All information found and reported on a claim is correct and should be supported with patient documentation.
• Make sure to be specific when creating clinical documentation.

Final Words

The ICD-10-CM code for diagnosing and billing Obstructive Sleep Apnea is G47.33. This code is used for both age groups, i.e., adults and children, except newborn babies.

Using this code accurately for a patient’s condition mandates correct diagnosis, complete documentation, following compliant coding guidelines, and using best practices.

Healthcare providers can only ensure correct and efficient coding for Obstructive Sleep Apnea when they are clear regarding the patient’s symptoms, related codes, and their proper usage.