While You Were Sleeping

By Coding Strategies on February 27th, 2015

ICD-10-CM has received criticism because there are codes for an injury due to an explosion on a sailboat (V93.54XA), person battered while on the outside of a dune buggy in traffic (V86.23XA), a person struck by falling objects during a cave in (W20.0XXA, code first any cataclysm or lightning strike) and an individual hurt during the explosion of a bicycle tire (W37.0XXA). In fact, there is even an ICD-10-CM code for a paper cut (W45.1XXA).

However, these codes may pale in comparison to some of the new DSM-5 codes. At an October 2014 meeting of the Academy of Psychiatry and Law, Dr. Brandon Moore, MD discussed the condition of “sexsomnia” which means engaging in sexual activity while asleep and the corresponding new DMS-5 diagnosis code. This is a rare parasomnia that may be a side effect of some insomnia drugs, occur due to drug or alcohol use, relate to sleep apnea or result from sleep deprivation. There is even a theory that there is a genetic link for sexsomnia. A study was published in the Journal of Clinical Sleep Medicine that discussed nine criminal cases where sexsomnia was used as a defense (the outcome favored the defendant in seven of those cases).

Most of us are familiar with sleep disorder terms such as insomnia (ICD-10-CM codes G47.00 or G47.01), “sleepwalking” (codes F51.3, somnambulism, or F44.89, hysterical sleep walking), obstructive sleep apnea (code G47.33), night terrors (code F51.4), jet lag (code G47.25), restless leg syndrome (code G25.81) and maybe even narcolepsy (code G47.419). There are also individuals affected with a night-eating syndrome or sleep-eating disorder (code F51.8) and sleep-related bruxism (code G47.63).

The bad news, from an ICD-10-CM coding standpoint, is that sexsomnia is not listed in the current edition of the ICD-10-CM Manual. Instead, there are codes for an emotional sleep disorder (F51.9), a general code for an unspecified sleep disorder (G47.9) and a code for other specified sexual dysfunction (F52.8). The good news is that not only can sexsomnia be accurately coded in DSM-5, it can be treated. Psychology Today published an article in February 2009 that states treatment may include medication such as bedtime benzodiazepines, CPAP for any existing sleep apnea and anticonvulsant drugs when medically indicated. As Plutarch so aptly stated “All men whilst they are awake are in one common world; but each of them, when he is asleep, is in a world of his own.”