Internal Medicine Coding Alert
Don't Fall for These Migraine Diagnosis Coding Pitfalls
Report specific ICD-9 codes or get ready for denials Because the ICD-9 manual provides several choices for migraine headache diagnoses, you shouldn't let your internist rely on unspecified code 346.9x to get his E/M services paid. You're in Trouble Without Fifth Digits The only way internists and coders can submit the most appropriate ICD-9 codes for migraines is to understand the different forms of migraines and the proper fifth digits they must attach to the codes. Depending on the medication's effectiveness, you should attach one of the above fifth digits to the following ICD-9 codes:
The reason: Suppose your internist frequently sees a patient for migraine headaches, which the doctor has diagnosed as unspecified (346.9x). If the insurance company reviews the claims, it may wonder why your physician couldn't determine a specific migraine after three or four visits, says Mary-Ellen Johnson, CPC, CPC-H, compliance educator for Spartanburg Regional Healthcare System in South Carolina.
You should also know that many insurance companies place limits on how many visits certain conditions require, Johnson says. For example, a carrier may allow more office visits for a cluster migraine (346.2x, Variants of migraine) than an unspecified migraine.
The bottom line: Always be certain that the medical-necessity documentation supports the E/M level you bill. Generally, you should not report 99215 for a patient the internist re-evaluated for migraines that have not changed in character, IM coding experts say.
What you need: Here are the fifth digits your physician should use to let carriers know whether the patient responds to medications:
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