Valid for Submission
Z73.811 is a billable code used to specify a medical diagnosis of behavioral insomnia of childhood, limit setting type. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Z73.811 might also be used to specify conditions or terms like behavioral insomnia of childhood or behavioral insomnia of childhood, limit setting type or limit-setting sleep disorder. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
The code Z73.811 is applicable for patients aged 0 through 17 years inclusive. It is clinically and virtually impossible to use this code on a patient outside the stated age range.
| ICD-10: | Z73.811 |
| Short Description: | Behavioral insomnia of childhood, limit setting type |
| Long Description: | Behavioral insomnia of childhood, limit setting type |
Index to Diseases and Injuries
The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code Z73.811 are found in the index:
- - Insomnia (organic) - G47.00
- - behavioral, of childhood - Z73.819
- - limit setting type - Z73.811
- - behavioral, of childhood - Z73.819
Code Edits
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:
- Pediatric diagnoses - Pediatric. Age range is 0–17 years inclusive (e.g., Reye’s syndrome, routine child health exam).
- Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual’s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.
Synonyms
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Behavioral insomnia of childhood
- Behavioral insomnia of childhood, limit setting type
- Limit-setting sleep disorder
Present on Admission (POA)
Z73.811 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .
CMS POA Indicator Options and Definitions
| POA Indicator Code | POA Reason for Code | CMS will pay the CC/MCC DRG? |
|---|---|---|
| Y | Diagnosis was present at time of inpatient admission. | YES |
| N | Diagnosis was not present at time of inpatient admission. | NO |
| U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
| W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
| 1 | Unreported/Not used - Exempt from POA reporting. | NO |
Convert Z73.811 to ICD-9
- V69.5 - Behav insomnia-childhood (Approximate Flag)
Code Classification
Code History
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
(First year ICD-10-CM implemented into the HIPAA code set) - FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020