How to Bill and Code for Parasomnia, a Primary Sleep Disorder

Hello and welcome to our podcast series. My name is Meghann Drella and I am a Senior Solutions Manager here at Outsource Strategies International. Today I will be discussing billing and coding for parasomnia, a primary sleep disorder.

00:13 – Introduction to Sleep Disorders

Sleep disorders can directly affect a person’s overall health and quality of life. Good sleep is essential to maintain optimal health, and sleep disorders can significantly affect hormone levels, mood, body weight and increase your risk of other health problems. Common signs and symptoms associated with these sleep disorders include – excessive daytime sleepiness, irregular breathing or increased movement during sleep.

There are different types of sleep disorders – each is grouped under specific categories that explain or give reasons on why these conditions occur and how they affect an individual’s quality of life. Parasomnia is one such unique sleep disorder that causes abnormal behavior while sleeping. This is a broad term used to describe disruptive behavioral or physiological events occurring in association with sleep, specific-sleep stages or sleep-wake transitions. Often referred to as “Bumps in the Night” in the sleep medicine field, this may include abnormal movements, behavior, emotions or dreams. Although these behaviors may appear complex and purposeful to others, patients may remain asleep during the event and in most cases, do not have a complete memory of what events occurred during the night. If left untreated, parasomnias can be disruptive to both the patient and the bed partner and can lead to severe psychological stress. Sleep medicine specialists who treat patients need to correctly diagnose the symptoms, causes and understand the various types of parasomnias.

01:41 – Top Causes

There are several causes of parasomnias, each associated with multiple triggers like – stress, anxiety, substance use, depression, irregular sleep schedules/disorders, use of certain medications, sleep deprivation and certain neurological conditions like Parkinson’s disease.

01:58 – Types of Parasomnias

There are different types of parasomnias. Some can occur during the first half of the night, from non-rapid eye movement sleep, while others can occur during arousals from REM (rapid eye movement) sleep, later in the night. Primary parasomnias are disorders of sleep states, while secondary parasomnias are disorders of the other organ systems that arise during sleep.

02:20 – Non-REM Parasomnias

• Sleep terrors/night terrors – These regarded as a disorder of arousal. The patient with this sleep disorder awakes from sleep in a frightened state, often accompanied by crying or screaming, with an increase in heart rate or sweating. The person may be awake during this stage but may be unable to communicate properly.
• Sleepwalking – This type of parasomnia occurs when a person appears to be awake and moving around with the eyes wide open, but is actually asleep and
• Confusional arousals – this can occur when a person gets awakened from deep sleep during the first part of the night and remains in a confused manner.

02:55 – REM Parasomnias

• Sleep paralysis – In this type of sleep disorder, a patient may not be able to move the body when falling asleep or waking up due to their muscles being paralyzed, even when they are awake.
• REM sleep behavior disorder (RBD) – People with this sleep condition act out unpleasant dreams during REM sleep. They may display forceful arm and leg movements and also make sounds.
• Nightmares – People see vivid dreams during sleep that can cause feelings of fear, terror, and/or anxiety.

03:27 – Symptoms

Apart from the unusual behavior during sleep time, parasomnia involves other symptoms like –

• Excessive daytime sleepiness or fatigue
• Finding unfamiliar cuts on your body
• Having difficulty sleeping throughout the night
• Not remembering doing certain activities, and
• Waking up confused or disoriented

03:46 – How to  Diagnose and Treat Parasomnia

Diagnosis of parasomnia sleep disorder is done by a sleep medicine specialist. A sleep specialist will analyze the patient’s sleeping pattern and behavior. As part of the diagnosis, these specialists may at times ask patients to maintain a sleep journal where they can note down the details of their sleep patterns like what time they went to sleep and what time they wake up from their sleep. Physicians will also ask details about underlying medical conditions, current medications, family history, and lifestyle behavior. In some cases, a polysomnogram may be performed wherein a patient may sleep in a lab overnight and the sleep specialist may analyze the sleeping behavior. Physicians may record the brain waves, breathing, and heart rate to make a diagnosis.

Treatment for this condition, in most cases depends on the type and severity of the parasomnia. Common treatment options include medications and cognitive behavioral therapy (CBT). In addition, physicians may also suggest some home treatments like  scheduled awakenings and arranging a safe sleep environment for patients. All diagnoses, screening and treatment procedures must be carefully documented using the correct medical codes.

Parasomnia is a complex sleep disorder that can affect the quality of sleep and increase the risk of accidents and health problems due to lack of rest. Patients need to immediately contact a sleep specialist if they notice any abnormal sleep-related behaviors. They should make it a habit to maintain a normal sleep schedule to get enough sleep.

I hope this helps but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed. Thank you for joining me and stay tuned for my next podcast.