G47.411
BillableNarcolepsy with cataplexy
HCC Category Mapping
RxHCCHCC 355 — Narcolepsy
0.000What This Code Means
A sleep disorder where a person experiences sudden, uncontrollable episodes of muscle weakness or paralysis (cataplexy) triggered by strong emotions, along with excessive daytime sleepiness.
Coding Tips
- •Cataplexy is a key distinguishing feature - document whether muscle weakness episodes are present
- •Narcolepsy type 1 includes cataplexy; ensure documentation supports this diagnosis before coding
Clinical Significance
Narcolepsy with cataplexy (Type 1 narcolepsy) is a chronic neurological disorder caused by loss of hypocretin/orexin-producing neurons, resulting in excessive daytime sleepiness and sudden loss of muscle tone triggered by emotions. This is the most severe form of narcolepsy and significantly impacts patient safety (driving, operating machinery) and quality of life. It maps to RxHCC 355, reflecting the substantial pharmacy costs of wake-promoting agents and cataplexy-specific medications.
Documentation Requirements
- ✓Diagnosis of narcolepsy with documented excessive daytime sleepiness
- ✓Cataplexy episodes documented: sudden bilateral loss of muscle tone triggered by strong emotions
- ✓Sleep study results: Multiple Sleep Latency Test (MSLT) showing mean sleep latency <=8 minutes with >=2 sleep-onset REM periods
- ✓OR cerebrospinal fluid hypocretin-1 levels <=110 pg/mL (definitive for Type 1)
- ✓Impact on daily functioning and safety assessment documented
- ✓Current medication regimen (stimulants, sodium oxybate, pitolisant, solriamfetol)
- ✓Exclusion of other causes of excessive daytime sleepiness
Commonly Confused Codes
G47.419 (Narcolepsy without cataplexy) — Type 2 narcolepsy; lacks the cataplexy componentG47.10 (Hypersomnia, unspecified) — nonspecific excessive sleepiness without narcolepsy diagnosisG47.421 (Narcolepsy in conditions classified elsewhere, with cataplexy) — use when narcolepsy is secondary to another conditionF51.11 (Hypersomnia due to a mental disorder) — psychiatric cause of excessive sleepinessG47.31-G47.39 (Sleep apnea) — can cause excessive daytime sleepiness but is a respiratory disorder
Code Hierarchy
└G47Sleep disorders└G47.4Narcolepsy and cataplexy└G47.41Narcolepsy└G47.411Narcolepsy with cataplexy
└G47.411Narcolepsy with cataplexy