2021 ICD-10-CM Code Z73.811
Behavioral insomnia of childhood, limit setting type
Valid for Submission
Z73.811 is a billable diagnosis code used to specify a medical diagnosis of behavioral insomnia of childhood, limit setting type. The code Z73.811 is valid during the fiscal year 2021 from October 01, 2020 through September 30, 2021 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, 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 |
Code Classification
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 - The Medicare Code Editor detects inconsistencies in pediatric cases by checking a patient's age and any diagnosis on the patient's record. The pediatric code edits apply to patients 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.
Approximate 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 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code Z73.811 its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
- V69.5 - Behav insomnia-childhood (Approximate Flag)
Information for Patients
Insomnia
What is insomnia?
Insomnia is a common sleep disorder. If you have it, you may have trouble falling asleep, staying asleep, or both. As a result, you may get too little sleep or have poor-quality sleep. You may not feel refreshed when you wake up.
What are the types of insomnia?
Insomnia can be acute (short-term) or chronic (ongoing). Acute insomnia is common. Common causes include stress at work, family pressures, or a traumatic event. It usually lasts for days or weeks.
Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.
Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.
Who is at risk for insomnia?
Insomnia is common. It affects women more often than men. You can get it at any age, but older adults are more likely to have it. You are also at higher risk of insomnia if you
- Have a lot of stress
- Are depressed or have other emotional distress, such as divorce or death of a spouse
- Have a lower income
- Work at night or have frequent major shifts in your work hours
- Travel long distances with time changes
- Have an inactive lifestyle
- Are African American; research shows that African Americans take longer to fall asleep, don't sleep as well, and have more sleep-related breathing problems than whites.
What are the symptoms of insomnia?
Symptoms of insomnia include:
- Lying awake for a long time before you fall asleep
- Sleeping for only short periods
- Being awake for much of the night
- Feeling as if you haven't slept at all
- Waking up too early
What other problems can insomnia cause?
Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. Insomnia also can cause other serious problems. For example, it could make you may feel drowsy while driving. This could cause you get into a car accident.
How is insomnia diagnosed?
To diagnose insomnia, your health care provider
- Takes your medical history
- Asks for your sleep history. Your provider will ask you for details about your sleep habits.
- Does a physical exam, to rule out other medical problems that might cause insomnia
- May recommend a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.
What are the treatments for insomnia?
Treatments include lifestyle changes, counseling, and medicines:
- Lifestyle changes, including good sleep habits, often help relieve acute (short-term) insomnia. These changes might make it easier for you to fall asleep and stay asleep.
- A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia
- Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule
If your insomnia is the symptom or side effect of another problem, it's important to treat that problem (if possible).
NIH: National Heart, Lung, and Blood Institute
- Changing your sleep habits (Medical Encyclopedia)
- Insomnia (Medical Encyclopedia)
- Medicines for sleep (Medical Encyclopedia)
[Learn More]
Code History
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)