Anesthesia Coding Alert

Question: Some of our less experienced coders need help pinpointing the correct diagnosis code for headache patients. At times, this is due to their newness to the practice. Other times, it’s because information is missing from the chart, and they need to track down the provider for the details. Do you have any advice on how we can remedy this?

Colorado Subscriber

Answer: Selecting a headache diagnosis certainly can be tricky to get exactly right. Some practices find it helpful to share a decision tree with their coders (and possibly providers). This can help ensure everyone stays on track.

Here’s an example of how you might want to structure a decision tree for choosing the most appropriate headache diagnosis code:

1. What is the headache type? These will be the base codes for your headaches. They would likely include codes for:

• Migraine
• Cluster
• Vascular
• Tension-type
• Posttraumatic
• Drug-induced (specify drug)
• Other

2. Is the headache intractable or not intractable? If applicable, the intractable or not intractable question can be vital to securing the correct ICD-10 code.

3. What is the timing of the headache? Some headache types are broken down further by the timing of the headache. Types of timing can include:

• Episodic;
• Chronic;
• Episodic paroxysmal hemicrania;
• Chronic paroxysmal hemicrania; and
• Short lasting unilateral.