2025 ICD-10-CM code F51.05
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Mental, Behavioral and Neurodevelopmental disorders - Sleep disorders not due to a substance or known physiological condition Mental, Behavioral and Neurodevelopmental disorders (F01-F99) Feed
Insomnia due to other mental disorder; requires additional code for the associated mental disorder.
Not applicable to ICD-10 codes. Modifiers are used with procedural codes (CPT, HCPCS).
Medical necessity is established by documenting the presence of insomnia directly related to another mental health disorder, impacting the patient's daily functioning and well-being.Clinical findings and treatment rationale must support the diagnosis and intervention.
The clinical responsibility involves a thorough evaluation of the patient's sleep disturbance, identification of the underlying mental health condition, and development of an appropriate treatment plan that addresses both the insomnia and the primary mental health concern.This might include ordering diagnostic tests, prescribing medication, and/or referring the patient for psychotherapy.
In simple words: This code means the person has trouble sleeping because of another mental health problem, like depression or anxiety.You must also add a code for the other mental health issue.
Insomnia due to other mental disorder refers to a sleep disturbance characterized by difficulty falling asleep or staying asleep, caused by another co-existing mental health condition.This code necessitates the inclusion of an additional code specifying the associated mental disorder (e.g., depression, anxiety, PTSD, OCD, schizophrenia).The diagnosis is established through patient history, symptom evaluation, behavioral assessment, and potentially polysomnography, EEG, or genetic testing. Treatment strategies vary depending on the underlying mental disorder and may involve medications (anxiolytics, hypnotics), psychotherapy (CBT-I), and lifestyle modifications.
Example 1: A patient presents with chronic insomnia and is diagnosed with major depressive disorder.F51.05 is used along with the code for major depressive disorder., A patient with generalized anxiety disorder experiences significant sleep disturbances.F51.05 is used along with the code for generalized anxiety disorder., A veteran with PTSD reports persistent nightmares and insomnia.F51.05 is used in conjunction with the PTSD code.
Detailed patient history including sleep patterns, symptoms, and mental health history; results of any diagnostic tests (polysomnography, EEG); treatment plan including medication, therapy, and lifestyle modifications; documentation of the co-existing mental disorder.
** This code is used only when insomnia is directly attributed to another mental health condition.If insomnia is due to a medical condition or substance use, a different code is required.
- Revenue Code: This will depend on the specific services provided and the payer's guidelines. Consult your local fee schedule and coding guidelines for accurate revenue code selection.
- RVU: RVUs are not directly assigned to ICD-10 codes. Reimbursement is determined by the associated procedural codes and the payer's fee schedule.
- Global Days : Not applicable to ICD-10 codes. Global surgical periods are associated with CPT codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Fee Schedule : Not applicable to ICD-10 codes. Fee schedules apply to procedural codes and are payer-specific.
- Specialties:Psychiatry, Sleep Medicine, Psychology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Mental Health Facility