Take the headache out of migraine coding
Laura Smith, CPC, CPC-I, Reimbursement Specialist
With 10 subcategories of migraine codes, it’s no wonder coding this condition can give coders headaches. A migraine is different from a typical headache, making it very important for migraines to be coded accurately to ensure the patient receives the appropriate treatment. Migraine codes are found in the Diseases of the Nervous System and Sense Organs section of the Tabular List of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), whereas headaches are located in the Symptoms, Signs, and Ill-Defined Conditions section. Keep in mind that migraines are a severe, recurring vascular headache. Coding a mere symptom (typical headache) instead of a nervous system disease (migraines) may slow much-needed treatment—and reimbursement.
Migraines are coded with ICD-9-CM code 346.xx and require fourth and fifth digits to further define the specificity and type of migraine. As with coding any condition, it is important to review the provider’s entire document to bring you to the appropriate code selection. If, for instance, the provider documents in his/her note that the patient’s headaches are preceded with visual symptoms such as flashing lights or blind spots, you would code this as migraine with aura, 346.0x, using the fifth digit to classify it as intractable, not intractable, status migranosus, or non-status migranosus. (See below for more information on coding aura.)
So, how can you determine whether to code for a migraine (346.xx) or a typical headache (784.0)? Just because a provider states “headache” in the documentation, doesn’t mean you should automatically code 784.0. Some key words in the documentation that would direct you to the 346.xx migraine codes are: menstrual or premenstrual headache, sick headache, periodic headache in child or adolescent, migraine type headache, or vasomotor headache. The Alphabetic Index will point you to the proper migraine code for any of these key words, making this one more example of how important it is to use both the Alphabetic Index and the Tabular List and not to rely on “cheat sheets” or assume all headaches are coded as 784.0.
Another source of frustration when coding migraines is determining whether to code a migraine with aura, 346.0x, or without aura, 346.1. Confusion often stems from the terms “classic” vs. “common.” These terms are so similar that when you look up “classic,” one of the synonyms is “common.” The key is to remember that a classic migraine is coded as a migraine with aura (346.0x), whereas a common migraine is coded as a migraine without aura (346.1x). Further adding to the difficulty, the term “aura” in itself is a potentially misleading term. For example, “persistent migraine aura” is coded as 346.5x if it is without cerebral infarction, and it is coded as 346.6x if it is with cerebral infarction. Just glancing at the term “aura” may cause coders to go right to 346.0x, migraine with aura, which would be incorrect coding.
As you can see, migraine coding can be headache-inducing; however, following proper coding steps and guidelines as well as utilizing the provider’s complete note will ensure coding to the highest level of specificity. If you have any questions regarding migraine coding or coding in general, please contact:
Laura Smith, CPC, CPC-I
1-888-588-4420 ext. 5933 (toll free)
Sources: American Academy of Professional Coders (AAPC) and OptumInsight. International Classification of Diseases, 9th Revision, Clinical Modification. 2012.
Mayo Clinic. “Migraine.”