OSA occurs when the airway becomes partially or fully blocked during sleep, leading to repeated pauses in breathing. Patients often present with loud snoring, excessive daytime sleepiness, morning headaches, poor concentration, and observed apnea episodes. Diagnosis is usually confirmed through a sleep study, either in-lab polysomnography or a home sleep apnea test.
From a clinical and billing perspective, OSA is considered a chronic condition that requires long-term management. Proper documentation by the provider is essential to support the ICD 10 code selection.
What is the ICD 10 Code for OSA?
The ICD 10 code used for Obstructive Sleep Apnea is:
G47.33:Obstructive sleep apnea (adult) (pediatric)
This code is used when OSA is confirmed by a sleep study and documented by a qualified provider. It applies to both adult and pediatric patients and is the standard diagnosis code accepted by Medicare and most commercial payers.
Other Related ICD 10 Codes for Sleep Apnea (OSA)
Depending on documentation and clinical findings, the following related codes may also apply:
- G47.30 – Sleep apnea, unspecified
Used when sleep apnea is documented but the type is not specified. This code should be avoided when possible due to limited payer acceptance. - G47.31 – Central sleep apnea
Used when apnea is caused by the brain failing to send proper signals to breathe. - G47.39 – Other sleep apnea
Used for sleep apnea types that do not fall under obstructive or central categories.
Accurate code selection depends entirely on provider documentation and sleep study results.
Services Covered Under ICD 10 Code G47.33
When G47.33 is correctly reported, it typically supports coverage for the following services:
- Diagnostic sleep studies including in-lab polysomnography
- Home sleep apnea testing when criteria are met
- CPAP, BiPAP, and APAP therapy devices
- CPAP supplies such as masks, tubing, and filters
- Follow-up visits for sleep apnea management
- Compliance monitoring and therapy adjustments
Coverage requirements may vary by payer, but OSA must be clearly documented as obstructive and confirmed.
Coding History and Updates
The ICD 10 code G47.33 has been in use since the transition from ICD 9 to ICD 10 in October 2015. It replaced ICD 9 code 327.23. Since its introduction, the code has remained stable with no major revisions, making it a reliable long-term diagnosis code for OSA.
Usage Instructions for G47.33
Proper usage of the OSA diagnosis code requires the following:
Includes
- Documented obstructive sleep apnea
- Sleep study confirmed diagnosis
- Adult and pediatric OSA cases
- OSA requiring CPAP or related therapy
Excludes
- Central sleep apnea without obstruction
- Sleep apnea not yet confirmed by testing
- Snoring without apnea diagnosis
- Temporary sleep-related breathing issues
The code should only be assigned after diagnostic confirmation unless payer guidelines allow provisional coding.
CPT Code Pairing Guide for OSA (ICD-10: G47.33)
Correct CPT pairing is critical to get sleep studies and CPAP claims paid. Below are the most commonly accepted CPT codes used with OSA.
Diagnostic Sleep Study CPT Codes
- 95810
In-lab polysomnography with sleep staging and four or more parameters. Used when a technician is present throughout the study. - 95811
Polysomnography with CPAP, BiPAP, or oxygen titration. Often billed after OSA diagnosis is confirmed. - 95806
Sleep study with respiratory effort, airflow, and oxygen saturation. Used less frequently but accepted in specific cases.
Home Sleep Apnea Testing CPT Codes
- 95800
Home sleep test measuring respiratory effort and airflow. - 95801
Home sleep test with additional sleep time measurement. - G0398 – G0400
Medicare-specific codes for unattended home sleep studies.
CPAP and DME Related Codes
- E0601
CPAP device for OSA treatment. - A7030 – A7046
CPAP supplies including masks, tubing, headgear, filters, and humidifiers.
Payer Coverage Checklist for OSA Claims
Before submitting claims under G47.33, confirm the following to avoid denials:
- OSA diagnosis is confirmed by a sleep study
- Sleep study report is signed and dated
- Symptoms are documented such as snoring, daytime sleepiness, or witnessed apnea
- CPAP therapy is ordered by a qualified provider
- Compliance documentation is available when required
- Face-to-face evaluation is completed within payer time limits
Medicare typically requires documented improvement and usage data for continued CPAP coverage.
Common Denial Reasons and How to Avoid Them
Most OSA claim denials happen due to documentation gaps. Watch out for these issues:
- Using G47.30 instead of G47.33
- Missing sleep study interpretation
- Billing CPAP without confirmed diagnosis
- Lack of therapy compliance records
- Home sleep test not meeting payer criteria
Clear diagnosis language and correct CPT pairing solve most problems.
Coding Audit Tips for Obstructive Sleep Apnea
To stay audit-safe, follow these best practices:
- Do not code OSA without objective testing
- Avoid unspecified sleep apnea codes when OSA is documented
- Match CPT services exactly to the study performed
- Ensure DME start dates align with diagnosis dates
- Maintain CPAP compliance reports in the chart
Auditors expect progression from diagnosis to treatment. Repeated testing without justification can raise red flags.
Final Coding Tip
G47.33 is a strong, stable diagnosis code when used correctly. Pair it with the right CPT codes, document thoroughly, and follow payer rules. Do that, and your OSA claims usually fly through without drama.
