2025 ICD-10-CM code G47.00
(Active) Effective Date: N/A Diseases of the nervous system - G47.0 6 Feed
Insomnia, unspecified. Difficulty falling asleep or staying asleep, despite adequate opportunity and circumstances for sleep.
Medical necessity for treatment is established by documenting the impact of insomnia on the patient's daytime functioning and quality of life. This can include difficulty concentrating, fatigue, irritability, and reduced performance at work or school.The severity and chronicity of the insomnia also play a role in determining medical necessity.
Clinicians diagnose insomnia based on patient-reported sleep history, duration and frequency of symptoms, and a physical exam.A sleep study (polysomnography) may be conducted for further evaluation. Treatment may include lifestyle changes, cognitive behavioral therapy (CBT), or medication.
In simple words: This code is used when someone has trouble falling asleep or staying asleep, even when they have enough time and a good place to sleep. The specific reason for the sleep problem isn't known.
This code represents insomnia that does not fit into the other more specific insomnia categories.It is characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep even when there is sufficient time and a suitable environment for sleep.The cause or type of insomnia is not specified.
Example 1: A patient reports difficulty falling asleep most nights for the past month due to stress at work. No other underlying medical or psychological conditions are identified., A patient complains of waking up frequently during the night and feeling tired during the day.The reason for the awakenings is unclear., A new parent reports disrupted sleep due to their baby's nighttime feedings. This has been happening for the last three months. The provider determines it is unspecified insomnia since other types of insomnia would not fit this situation.
Documentation should include the patient's sleep history (sleep patterns, duration, and frequency of difficulty), associated symptoms (daytime fatigue, irritability, concentration problems), the duration of the sleep disturbance, any potential contributing factors (stress, lifestyle factors, medical conditions), and the impact on daily activities. If a sleep study is performed, its findings should be included.
- Payment Status: Active
- Specialties:Sleep medicine specialists, neurologists, psychiatrists, primary care physicians
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home