2025 ICD-10-CM code F51
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Mental, Behavioral and Neurodevelopmental disorders - Behavioral syndromes associated with physiological disturbances and physical factors Mental, Behavioral and Neurodevelopmental disorders (F01-F99) Feed
Sleep disorders not due to a substance or known physiological condition.
Modifiers may be applicable depending on the specific circumstances of service delivery.Consult the official CPT and ICD-10-CM guidelines for modifier use and appropriate application.
Medical necessity for the diagnosis and treatment of F51 is established when the sleep disturbance causes significant distress or impairment in daily functioning. This may manifest as daytime fatigue, difficulty concentrating, impaired mood, or impact on social or occupational performance.The treatment plan should be tailored to the individual patient and based on established clinical guidelines.
The clinical responsibility for diagnosing and managing F51 falls on healthcare professionals such as psychiatrists, psychologists, sleep specialists, or primary care physicians. Their responsibilities include taking a detailed patient history, performing a physical exam, ordering diagnostic tests (if necessary), developing a treatment plan (which may include medication, therapy, lifestyle changes), monitoring treatment effectiveness, and providing patient education.
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- F50-F59 (Behavioral syndromes associated with physiological disturbances and physical factors)
In simple words: This code covers sleep problems not caused by drugs, alcohol, or a physical illness.It includes things like trouble sleeping (insomnia), excessive sleepiness (hypersomnia), sleepwalking, and nightmares. Doctors consider the patient's history, symptoms, lifestyle, and physical exam to diagnose the problem. Treatment may involve medication, therapy, relaxation techniques, and exercise.
This ICD-10-CM code encompasses sleep disorders that are not caused by a substance or an identifiable physiological condition.These are psychogenic sleep disorders and include, but are not limited to, insomnia (difficulty falling asleep or staying asleep), hypersomnia (excessive daytime sleepiness despite adequate sleep), sleepwalking, night terrors, and nightmares.The diagnosis is made considering patient history, symptoms, personal and social behavior, and physical examination. Diagnostic tools like polysomnography, EEG, and genetic testing may also be used. Treatment is individualized based on the cause and may include medications (anxiolytics, sedatives, melatonin), cognitive behavioral therapy (CBT) focused on sleep hygiene, relaxation/meditation, and exercise.
Example 1: A 35-year-old female presents with chronic insomnia, reporting difficulty falling asleep and frequent awakenings for the past six months. She denies substance use and has no known medical conditions.A thorough history reveals significant work-related stress and relationship problems.The physician diagnoses F51 and initiates CBT for sleep hygiene and stress management., A 60-year-old male reports excessive daytime sleepiness and difficulty staying awake throughout the day. A sleep study is ordered and rules out any sleep apnea.A detailed history reveals long-standing anxiety and depression. The physician diagnoses F51 and refers the patient to a psychiatrist for evaluation and management of the underlying mood disorder., A 16-year-old male is referred for recurrent sleepwalking episodes that have been occurring for several years. The episodes typically occur during the first few hours of sleep and there is no evidence of nocturnal seizures or sleep apnea. The physician diagnoses F51 and recommends lifestyle modifications, and considers a short course of melatonin to improve sleep consolidation.
Detailed patient history including sleep patterns, daytime symptoms, medical and psychiatric history, substance use, and relevant psychosocial factors.Results of any diagnostic testing (sleep study, EEG). Documentation of treatment plan, including medication(s) prescribed, therapy sessions, and patient education.
** Consider the impact of comorbidities on the sleep disorder and code accordingly. For example, if the sleep disturbance is directly attributable to an existing psychiatric condition, appropriate codes for the underlying condition should also be used in conjunction with F51. Always refer to the most up-to-date coding manuals and guidelines for accurate billing practices.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule : Fee schedules are not directly associated with ICD-10 codes. Reimbursement depends on other factors including payer, place of service, and associated evaluation and management services.
- Specialties:Psychiatry, Sleep Medicine, Neurology, Family Medicine, Internal Medicine
- Place of Service:Office, Hospital (Inpatient and Outpatient), Mental Health Facility, Sleep Clinic