ED Coding and Reimbursement Alert

Question: Some of our coders are having trouble getting the ICD-10-CM codes for our headache patients correct. At times, there is one piece of information missing in the notes, and we have to run the provider down to get the missing info. Is there any way to remedy this? To be clear, our issue isn’t finding the right code — it’s finding the details that will allow us to come to the right code.

Iowa Subscriber

Answer: You might want to show your providers (and coders) a decision tree that can make sure everyone stays on track with headache diagnoses, which can be notoriously difficult to get exactly right.

Follow these steps to get started on your own decision tree:

1. What is the headache type? These will be the base codes for your headaches. They would likely include codes for:

• Migraine
• Cluster
• Vascular
• Tension-type
• Posttraumatic
• Drug-induced (specify drug)
• Other

2. Is the headache intractable or not intractable? If applicable, the intractable or not intractable question can be vital to securing the correct ICD-10 code.

3. What is the timing of the headache? Some headache types are broken down further by the timing of the headache. Types of timing can include:

• Episodic
• Chronic
• Episodic paroxysmal hemicrania
• Chronic paroxysmal hemicrania
• Short lasting unilateral.

Once you have these details, you’ll be able to select the best headache code. Make sure your ED providers are documenting this information in every progress note to ensure your coders can choose the best code.