Anesthesia Coding Alert

Intractable vs. non-intractable can set your reimbursement success

Before coding for migraine treatment, be sure you’re using the correct diagnosis. ICD-9 includes several choices in the 346.xx (Migraine) family, with fifth-digit classifications of 0 (without mention of intractable migraine) and 1 (with intractable migraine, so stated).

“Be sure to identify if the migraine is intractable or non-intractable,” says Marianne Wink-Sturgeon, RHIT, CPC, ACS-EM, with the University of Rochester Medical Center’s department of neurology. “This helps define the status and severity of the migraine.”

Example: Diagnosing a non-intractable migraine does not support the medical necessity of Botulinum injections as treatment. Some carriers, however, will approve Botulinum injections to treat an intractable migraine (346.91, Migraine, unspecified; with intractable migraine, so stated) once traditional treatments fail.