2025 ICD-10-CM code F51.1
Hypersomnia not due to a substance or known physiological condition.
ICD-10-CM codes do not use modifiers in the same way as CPT or HCPCS codes. Modifiers are used with procedural codes to provide additional information.
Medical necessity for the diagnosis and treatment of F51.1 is established when excessive daytime sleepiness significantly impacts a patient’s daily functioning, quality of life, and overall well-being.The severity of hypersomnia, the presence of associated symptoms (fatigue, mood disturbances, cognitive impairment), and the impact on occupational and social functioning should all be documented.The diagnosis should be supported by clinical findings that rule out other causes and demonstrate the need for treatment to address the hypersomnia.Specific medical necessity criteria may vary depending on payer requirements.
The clinical responsibility for diagnosing and managing F51.1 rests with a physician specializing in sleep medicine, psychiatry, or primary care, depending on the complexity of the case and presence of comorbid conditions.The provider will obtain a comprehensive patient history, perform a physical exam, and order relevant tests (polysomnography, multiple sleep latency test, etc.) to rule out underlying medical conditions. Treatment planning may involve medication management, counseling (psychological or sleep hygiene), and lifestyle modifications.
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
- F51.1 is under the broader category of F51 (Nonorganic insomnia and hypersomnia)
In simple words: Excessive daytime sleepiness that isn't caused by a physical problem or substance use.This means someone feels very sleepy during the day even if they slept well at night. It might be related to stress or mental health. Doctors might use tests like sleep studies to figure out what's causing it. Treatment could include medicine, counseling, or changes to lifestyle.
Hypersomnia not due to a substance or known physiological condition refers to excessive daytime sleepiness not explained by insufficient sleep or a known physical or substance-related cause.It is considered a psychogenic sleep disorder, meaning it's primarily caused by psychological factors.Patients often experience fatigue, difficulty concentrating, appetite changes, speech difficulties, irritability, anxiety, and restlessness. Diagnosis involves a thorough patient history, physical exam, evaluation of personal and social behavior, and may include polysomnography, multiple sleep latency testing, Epworth sleepiness scale, and a sleep diary. Treatment depends on the underlying cause and might include stimulant medications (e.g., amphetamine, methylphenidate), sleep hygiene counseling, substance use counseling, and dietary changes.
Example 1: A 35-year-old patient presents with chronic daytime sleepiness despite reporting adequate nighttime sleep. They struggle with concentration at work, have decreased appetite, and exhibit irritability and anxiety.Polysomnography is normal, ruling out sleep apnea.Diagnosis: F51.1.Treatment includes psychotherapy to address anxiety and sleep hygiene education., A 60-year-old patient with a history of major depressive disorder reports persistent excessive sleepiness, impacting their daily activities. They are currently receiving antidepressant medication. The sleepiness isn't directly attributable to the medication. Diagnosis: F51.1. Treatment could focus on optimizing the antidepressant regimen and/or adding another medication to combat hypersomnia. Psychological therapy is also warranted., A 22-year-old college student complains of persistent daytime sleepiness despite getting 8-10 hours of sleep nightly.They report feelings of fatigue, difficulty concentrating, and low mood. Initial workup excludes any significant medical or substance-related causes.Diagnosis: F51.1. Treatment involves exploring potential triggers contributing to the hypersomnia, implementing improved sleep hygiene, and managing any co-occurring anxiety or mood disorders.
Detailed patient history including sleep patterns, daytime sleepiness symptoms, medical history, substance use history, mental health history, medication list, and social history. Results of a physical examination and any relevant laboratory or diagnostic testing, including polysomnography or multiple sleep latency tests. Results of any sleep questionnaires (Epworth Sleepiness Scale, etc.). Documentation of any counseling or therapy sessions and any changes made to medications or other treatments.Documentation should explicitly rule out other possible causes of hypersomnia.
** Careful consideration should be given to differentiate F51.1 from other sleep disorders (e.g., narcolepsy, sleep apnea) and from hypersomnia secondary to substance use or medical conditions.Accurate diagnosis and appropriate coding require comprehensive documentation and clinical judgment.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Specialties:Sleep Medicine, Psychiatry, Neurology, Primary Care
- Place of Service:Office, Hospital (Inpatient or Outpatient), Sleep Clinic, Mental Health Clinic