ED Coding and Reimbursement Alert

You-ll soon need a 5th digit to avoid migraine code denials You can dig up the encounter details you-ll need to snag the correct migraine code this fall with our coding gurus- inside scoop on this slew of changes. ICD-9 2009 will premiere with about 30 new migraine codes, expanding the 346.xx series to its highest degree of specificity ever. To make this coding transition as painless as possible, use the following guidelines. The new deal: CMS recently released its preliminary ICD-9 2009 list, set to go into effect Oct. 1, 2008. The changes aren't official yet, but here's the lowdown on how these proposed changes will affect your migraine coding. 1. ID Migrainosus With These 5th-Digit Descriptors For each new migraine code, you-ll have fifth-digit options to indicate the presence of status migrainosus, which is a prolonged migraine that increases the patient's stroke risk, says coding expert Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga. The new and revised fifth-digit options include: - 0 -- Without mention of intractable migraine without mention of status migrainosus - 1 -- With intractable migraine, so stated, without mention of status migrainosus - 2 -- Without mention of intractable migraine with status migrainosus - 3 -- With intractable migraine, so stated, with status migrainosus. 2. Let 346.xx Take a Load Off Your Mind There are changes in the works for 346.0x (Classical migraine). According to ICD-9 2008, you use 346.0x to describe migraines with auras or migraines preceded or accompanied by transient focal neurological phenomena. The revised version of 346.0x will also include the following migraine types explicitly, says Stephen D. Silberstein, MD, FACP, past president of the American Headache Society, director of the Jefferson Headache Center and professor at Thomas Jefferson University Hospital in Philadelphia, in his presentation, "Headache Classification 2007" (http://www.cdc.gov/nchs/ppt/icd9/att1_headache_mar07.ppt): - classic migraine - basilar migraine - migraine-triggered seizures - migraine with acute-onset aura - migraine with aura without headache (migraine equivalents) - migraine with prolonged aura - migraine with typical aura - retinal migraine. Many entries in the new group of migraine codes specify whether or not an "aura" accompanies the headache. "An aura is a group of symptoms that occur in migraine sufferers in the minutes prior to the onset of the headache. They include visual disturbances, distortion of objects, flashing lights, lines across the visual field, etc.," Miller says. The patient may also feel dizzy and have problems with balance during an aura onset. But remember, "Not everyone who gets migraines experiences an aura," Miller says. 3. Even More Variety Added to 346.2x Until now, 346.2x (Variants of migraine) was something of a catchall for other migraine types, ranging [...]