Anesthesia Coding Alert

Expect to extend to the 5th — or often 6th — character.

Nearly everyone has experienced some form of the throbbing, uncomfortable, and distracting pain of a headache. We’ve examined the complexities of ICD-10-CM coding conventions for migraines in the past, but this barely scratches the surface, as there are hundreds of different headache types.

Peruse this primer to get a better handle on the ins and outs of coding some of the other common types of headaches that may cross your path.

Check Cluster Period Duration for These Headaches

Cluster headaches (CH), dubbed the most painful of all types by many, are severe, recurring headaches characterized by intense, unilateral pain typically around the eye or temple. These attacks occur in groups, or “clusters,” and have been described as “boring,” “burning,” and “like a hot poker in the eye.” Other symptoms associated with CH include tearing, redness of the eye, nasal congestion, or a drooping eyelid on the affected side.

During a cluster cycle, brief, excruciatingly severe headache attacks recur between one and eight times per day, with each headache lasting from 15 minutes to three hours. Cluster cycles can last for weeks or months and are usually separated by remission periods, or periods of headache freedom, which usually last months or years.

ICD-10-CM: When a patient has a cluster headache, you’ll choose from the following code sets:

• G44.00- (Cluster headache syndrome, unspecified)
• G44.01- (Episodic cluster headache)
• G44.02- (Chronic cluster headache)

Notes: Episodic headaches occur less frequently than chronic headaches. In episodic cluster headaches, the headaches occur off and on for one week to a year, followed by a pain-free remission period lasting three months or longer before another cluster headache develops. Whereas chronic cluster headaches might continue for more than a year, followed by a pain-free remission period that may last less than one month, if remission occurs at all. Check with your payer if you have questions about differentiating cluster headache codes.

Remember: You’ll turn to the unspecified codes when the provider documentation doesn’t specify whether the cluster headaches are episodic, chronic, intractable/not intractable.

Make sure to code to the 6th character to indicate whether the headache is intractable (“1”) or not intractable (“9”). An intractable headache is a severe, persistent headache that does not respond to traditional treatment methods. Whereas a headache that is “not intractable” responds well to typical treatment methods, such as over-the-counter pain relievers and rest.

Study These Definitions To Correctly Classify TTH

The most common type of headache is tension-type headache (TTH). Stress, sleep problems, and caffeine are often factors in these headaches. TTH occurs when neck and scalp muscles become tense or contract resulting in mild to moderate pain. Patients often describe feeling like a tight band around the head or dull pain in the back of the neck and shoulders, which may last 30 minutes to seven days and may worsen with stress, fatigue, or noise.

ICD-10-CM: Report tension-type headaches with one of the following code groups:

• G44.20- (Tension-type headache, unspecified)
• G44.21- (Episodic tension-type headache)
• G44.22- (Chronic tension-type headache)

Notes: Episodic TTH can last from 30 minutes to a week and is classified as infrequent (one or fewer episodes a month) or frequent (fewer than 15 episodes a month for at least three months). While chronic TTH lasts hours and may be continuous; the headaches occur 15 or more days a month for at least three months. Like with cluster headaches, you’ll have to code to the 6th character to indicate intractable versus not intractable.

Categorize Post-Traumatic Headaches Into Acute, Chronic

If a patient develops a headache within seven days after a head injury or trauma or after regaining consciousness, it could be a post-traumatic headache (PTH). These headaches can vary in intensity and duration.

Potential symptoms for PTH are numerous and include a dull, throbbing, or sharp pain on one or both sides of the head. Further potential symptoms include dizziness, difficulty concentrating, sensitivity to light or sound, and changes in sleep patterns.

ICD-10-CM: Choose from the following code sets for post-traumatic headaches:

• G44.30- (Post-traumatic headache, unspecified)
• G44.31- (Acute post-traumatic headache)
• G44.32- (Chronic post-traumatic headache)

Notes: Remember to account for acute (lasting less than three months) or chronic (lasting longer than three months) and intractable or not intractable when reporting PTH.

Delve Into Complicated Headache Details

ICD-10-CM also features a section devoted to complicated headache syndromes: G44.5- (Complicated headache syndromes). These codes are for rare headache disorders that are severe and/or persistent and difficult to diagnose and/or treat.

ICD-10-CM: Select from the following code sets to report complicated headache syndromes:

• G44.51 (Hemicrania continua)
• G44.52 (New daily persistent headache (NDPH))
• G44.53 (Primary thunderclap headache)

Hemicrania continua (HC): Chronic headache, usually features continuous unilateral head pain that varies in intensity and lasts at least three months, without pain-free periods and without changing sides. The affected side of the patient’s head or face can experience a constant, dull ache with occasional episodes of more severe pain associated with autonomic symptoms such as tearing, eye redness, nasal congestion, or a drooping eyelid on the affected side.