ED Coding and Reimbursement Alert

Question: I am still trying to wrap my head around the new migraine ICD-9 codes. Could you explain to me what ICD-9 means by -aura-? Also, what exactly is -status migrainosus-?

Florida Subscriber

Answer: Some of the new migraine codes specify whether or not the patient experienced an aura pre-migraine. These include, but are not limited to, 346.0x (Migraine with aura) and 346.1x (Migraine without aura). -Aura- definition: An aura is a group of symptoms that the patient may experience prior to the onset of a migraine. It usually includes visual disturbances, such as loss of part of the visual field, flashing lights, and lines across the visual field.

If notes indicate that the patient experienced any of the above symptoms, you-ll probably want to choose a migraine with aura code. Remember that not all migraine patients experience an aura, so it is vital that you know how to spot aura symptoms.

Migrainosus symptoms: Status migrainosus is an unrelenting, debilitating headache of severe intensity lasting more than 72 hours with less than an hour of painfree period. Severe dehydration and electrolyte depletion also occur due to nausea and vomiting. This condition may increase the patient's risk of stroke during the migraine. If you see these symptoms in the notes for a migraine patient, they likely have status migrainosus.

To represent the presence or absence of migrainosus, ICD-9 added these fifth-digit options for migraine codes:

- 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.

These fifth digits also specify whether a migraine is -tractable- or -intractable.- An intractable migraine is sustained and continual, and does not respond to normal treatment.