2025 ICD-10-CM code G47.01
(Active) Effective Date: N/A Episodic and paroxysmal disorders - Disorders of the nervous system 6 Feed
Insomnia due to a medical condition. It is important to also code the associated medical condition.
Medical necessity is established by demonstrating the insomnia is a direct consequence of the documented medical condition. The documentation should support how the medical condition impacts the patient's sleep and the resulting impairment in daily activities.
The provider should diagnose insomnia based on the patient's medical history, sleep patterns, symptoms, and a physical exam. Additional tests, such as a sleep study (polysomnogram), blood tests, urine tests, MRI, or CT scan might be necessary to identify the underlying medical condition causing the insomnia. Treatment focuses on addressing the root cause and could involve lifestyle changes, sleep habit modifications, cognitive behavioral therapy (CBT), and/or medication.
In simple words: Trouble sleeping because of a health problem. This could be anything from pain to a disease. You should also tell your doctor about the health problem that's causing your sleep issues.
Insomnia due to a medical condition refers to difficulty falling asleep or staying asleep caused by an underlying medical issue.Conditions such as chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), hyperthyroidism, Parkinson’s disease, and Alzheimer’s disease can lead to insomnia. The severity and duration of the insomnia often correlate with the underlying condition's severity and course.
Example 1: A patient with rheumatoid arthritis experiences chronic pain that makes it difficult to fall asleep and stay asleep throughout the night., A patient undergoing chemotherapy for cancer experiences insomnia as a side effect of the treatment., A patient with hyperthyroidism has difficulty falling asleep due to an increased metabolic rate and anxiety.
Documentation should clearly link the insomnia to the underlying medical condition. Details about the nature, severity, and duration of the sleep disturbance, along with any associated symptoms like fatigue, irritability, or difficulty concentrating, should be recorded. Diagnostic tests and their results, if performed, should also be documented.
** Conditions excluded from this code include alcohol-related insomnia (F10.182, F10.282, F10.982), drug-related insomnia (F11.-, F13.-, F14.-, F15.-, F19.- with .182, .282, .982 as 7th character), idiopathic insomnia (F51.01), insomnia due to a mental disorder (F51.05), nonorganic insomnia (F51.0-), and primary insomnia (F51.01).
- Payment Status: Active
- Specialties:Sleep medicine specialists, neurologists, primary care physicians, and other specialists depending on the underlying medical condition
- Place of Service:Inpatient Hospital, Office, Telehealth Provided in Patient’s Home, etc.