ED Coding and Reimbursement Alert

Look for cluster, tension and post-traumatic subsets You can easily navigate the 50-plus headache diagnosis codes expected to debut this fall if you zoom in on the type of headache. This primer will get you started with three newly defined types. Look for future issues of ED Coding Alert to showcase additional introduced types, such as migraines. Go to 339.0x for One-Sided Headaches Coders will want to take notice of a cluster of new headache codes set to take effect with the newest version of ICD-9 (339.00-346.83). "Clinical research has taken headache research much further," says Joan Gilhooly CPC, CHCC, president of Medical Business Resources in Chicago. This leap forward is reflected in the latest ICD-9 codes. New subcategory 339.0x (Cluster headaches and other trigeminal autonomic cephalgias [TACS]) will cover a variety of cluster headaches and headaches affecting one side of a subject's head. These include the following: - 339.00 -- Cluster headache syndrome, unspecified - 339.01 -- Episodic cluster headache - 339.02 -- Chronic cluster headache - 339.03 -- Episodic paroxysmal hemicrania - 339.04 -- Chronic paroxysmal hemicrania - 339.05 -- Short lasting unilateral neuralgiform headache with conjunctival injection and tearing - 339.09 -- Other trigeminal autonomic cephalgias. Note: Code 339.00 also includes cluster headache not otherwise specified (NOS), ciliary neuralgia, histamine cephalgia, lower half migraine, and migrainous neuralgia, while 339.03 includes paroxysmal hemicrania NOS. Take the Stress Out of Coding TTH ICD-9 2009 may also offer three new codes you can use for tension-type headaches (TTH): - 339.10 -- Tension type headache, unspecified - 339.11 -- Episodic tension type headache - 339.12 -- Chronic tension type headache. For these primary headache disorders, choose 339.11 (episodic) for headaches experienced fewer than 15 days per month, and 339.12 (chronic) for headaches that occur on more days than not for more than three months. PTH Gains 3 Codes Post-traumatic headaches (PTH) represent another headache category you may see in ICD-9 2009. PTH can be part of post-concussion syndrome, but it does not have to be. So if the ED physician documents PTH but doesn't document post-concussion syndrome, you may still be able to report one of the new PTH codes: - 339.20 -- Post-traumatic headache, unspecified - 339.21 -- Acute post-traumatic headache - 339.22 -- Chronic post-traumatic headache.