ED Coding and Reimbursement Alert
Using New Migraine ICD-9? Remember 5th Digit
Question: I am having trouble navigating the new ICD-9 codes for migraines. My encounter notes state that the ED physician provided a level-three E/M for a patient who had an "intractable basilar migraine with status migrainosus." I know the right diagnosis code is in ICD-9 2009, but which one is it? Illinois Subscriber Answer: To represent the patient's migraine type, report 346.03 (Migraine with aura; with intractable migraine, so stated, with status migrainosus). For the ED service, use 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...). ICD-9 2009 features upward of 30 new migraine codes, which means you must be a lot more specific when choosing a diagnosis code for your migraine claims. Base code: ICD-9 2009 calls for coders to use 346.0x (Migraine with aura) to represent basilar migraines. You should also use 346.0x for: - classic migraine - migraine proceeded or accompanied by transient focal neurological phenomena - 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. You-ll also have to select a fifth digit for this code based on whether or not status migrainosus is present. With 346.0x, choose from these fifth-digit options: - 0 ��" without mention of intractable migraine without mention of status migrainosus - 1 ��" with intractable migraine, so stated, without mention of status migrainosus - 3 ��" with intractable migraine, so stated, with status migrainosus
- 2 ��" without mention of intractable migraine with status migrainosus
ED Coding and Reimbursement Alert
- Spot E/M Evidence to Gain $130 When Ventilation Management Occurs
These tips help you identify higher-paying critical care versus ED E/M. If you fail to [...] - CPT Update:
Check Out Your Top Changes for 2009
Latest CPT axes prolonged E/M modifier --but offers EDs no alternative strategy. Starting Jan. 1, [...] - News You Can Use:
Begin Prepping for More Specific ICD-10 Today
New diagnosis-code book will change seizure codes -- and everything else. If you think keeping up [...] - You Be the Coder:
Observation or ED E/M Care?
Question: A 68-year-old patient with significant airflow limitation due to obstructive chronic bronchitis is admitted [...] - Reader Questions:
Reserve CPR Code for 'Lead' Physician
Question: When more than one physician participates in a CPR service for a patient, which [...] - Reader Questions:
Include Catheter Code on Critical Care Claim
Question: A 22-year-old motor-vehicle accident victim reports with multiple injuries, and the ED physician provides [...] - Reader Questions:
Using New Migraine ICD-9? Remember 5th Digit
Question: I am having trouble navigating the new ICD-9 codes for migraines. My encounter notes [...] - Reader Questions:
Global Period Drives Choice Between 25, 57
Question: I have never really understood what separated modifiers 25 and 57. Could you explain [...] - Reader Questions:
Think Twice Before Filing for Interpreter Service
Question: Which diagnosis code should I use with T1013 for using an interpreter with a [...] - Reader Questions:
ED Claims Cannot Contain EBV Screens
Question: A patient reports to the ED complaining of a sore throat, frequent fevers, and [...]
