2025 ICD-10-CM code F51.0
Insomnia not due to a substance or known physiological condition.
Medical necessity for this code requires that the insomnia significantly impacts the patient's daytime functioning and is not attributable to other medical or substance-induced causes. The documentation should clearly establish the diagnosis and justify the need for treatment.
The provider diagnoses the condition based on patient history, signs and symptoms, a detailed inquiry into personal and social behavior, and a physical examination. Other diagnostic tools might include polysomnography, EEG, and genetic testing. Treatment depends on the cause and may include medication (anxiolytics, sedatives, melatonin supplements), cognitive behavioral therapy (CBT), relaxation techniques, and exercise.
- 6 (Mental, Behavioral and Neurodevelopmental disorders)
- F50-F59 (Behavioral syndromes associated with physiological disturbances and physical factors)
In simple words: This code is used when someone has trouble sleeping, not because of drugs, alcohol, or a medical problem, but because of mental or emotional reasons like stress or anxiety.
This code refers to a psychogenic sleep disorder characterized by inadequate sleep due to difficulty falling asleep or staying asleep, despite sufficient time and opportunity for sleep.It is not caused by substance use or a known physiological condition. Potential causes include difficulty adjusting to stressors, sleep state misperceptions, or psychophysiological interactions.
Example 1: A patient experiences difficulty falling asleep and frequent awakenings during the night following the loss of a loved one. The symptoms have persisted for three weeks. The insomnia is not attributed to any substance use or medical condition., A patient reports chronic difficulty maintaining sleep due to worries about work and family responsibilities. They have ruled out substance use or medical conditions as the cause. Cognitive behavioral therapy and sleep hygiene interventions are recommended., A patient presents with complaints of inadequate, non-restorative sleep, despite having ample opportunity to sleep. They deny any substance use and have no known medical conditions affecting their sleep. Upon evaluation, the insomnia is determined to be related to ongoing emotional stress and anxiety.
Documentation should include details about the patient's sleep difficulties, duration of symptoms, any associated daytime impairments, relevant psychosocial stressors, substance use history, medical history, and mental health assessment. Any diagnostic tests performed (e.g., polysomnography, EEG) should also be documented.
- Specialties:Psychiatry, Psychology, Sleep Medicine, Primary Care
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home