ED Coding and Reimbursement Alert

Question: A patient presents to the ED with complaints of a headache that's worsening daily. He is experiencing visual blurring and nausea but no vomiting. This is the third headache of this nature in three weeks, and it has lasted "four or five days." Documentation indicates a detailed examination and history; after performing the assessment and speaking to the patient, the physician documents migraine with typical aura and status migrainosus. Treatment options include acute intervention with prescription, but the physician feels the patient needs to add prophylactic medicine treatments, since the headaches appear to be reoccurring. What migraine ICD-9 code represents this patient's headache?

Tennessee Subscriber

Answer: This sounds like a migraine with status migrainosus. On the claim, report the following:

• the appropriate-level E/M code based on the notes, such as 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused detailed history; an expanded problem focused detailed examination; and medical decision making of moderate complexity ...)

• 346.02 (Migraine with aura; without mention of intractable migraine with status migrainosus) appended to the E/M to represent the patient's headache

• 368.8 (Other specified visual disturbances) appended to the E/M to represent the patient's blurred vision

• 787.02 (Nausea alone) appended to the E/M to represent the patient's nausea.

Explanation: All of the migraine codes now include a fifth digit that indicates presence of status migrainosus. Since your patient reported a four-day migraine, it sounds like the patient was suffering from status migrainosus.