Internal Medicine Coding Alert

Learn the terms that help with tension, post-traumatic and cluster categories

Although the headache codes slated for an ICD-9 2009 debut are enough to make your temples start pounding, you can easily navigate the 50-plus new headache diagnosis codes if you zoom in on the specific type of headache.

This primer will get you started with three newly defined types. Look for future issues of Internal Medicine Coding Alert to showcase additional introduced types, such as migraines.

Coders should take notice of a cluster of new headache codes set to take effect with the newest version of ICD-9 -- 339.00-346.83.

"Clinical research has taken headache research much further," says Joan Gilhooly CPC, CHCC, president of Medical Business Resources in Chicago. This leap forward is reflected in the latest ICD-9 codes.

New subcategory 339.0x (Cluster headaches and other trigeminal autonomic cephalgias [TACS]) will cover a variety of cluster headaches and headaches affecting one side of a subject's head.

These include the following:

• 339.00 -- Cluster headache syndrome, unspecified

• 339.01 -- Episodic cluster headache

• 339.02 -- Chronic cluster headache

• 339.03 -- Episodic paroxysmal hemicrania

• 339.04 -- Chronic paroxysmal hemicrania

• 339.05 -- Short lasting unilateral neuralgiform headache with conjunctival injection and tearing

• 339.09 -- Other trigeminal autonomic cephalgias.

Code 339.00 also includes cluster headache not otherwise specified (NOS), ciliary neuralgia, histamine cephalgia, lower half migraine, and migrainous neuralgia, while 339.03 includes paroxysmal hemicrania NOS, said Stephen D. Silberstein, MD, FACP, past president of the American Headache Society, director of the Jefferson Headache Center and neurology professor at Thomas Jefferson University Hospital in Philadelphia, in his presentation, "Headache Classification 2007" (http://www.cdc.gov/nchs/ppt/icd9/att1_headache_mar07.ppt).

Codes 339.01-339.04 include the terms "episodic" and "chronic." Chronic denotes pain that persists more than three months.

Watch out: For primary episodic headache disorders, such as migraines, Silberstein says, use the classification "chronic" whenever headache occurs on more days than not for more than three months. Episodic means fewer than 15 days per month, he says.

Exception: Trigeminal autonomic cephalgias (TACs) are the exception, Silberstein says. The chronic classification isn't used for TACs until a subject has unremitting headaches for more than a year.

ICD-9 2009 may also offer three new codes you can use for tension-type headaches (TTH):

• 339.10 -- Tension type headache, unspecified

• 339.11 -- Episodic tension type headache

• 339.12 -- Chronic tension type headache.

These codes will exclude tension headaches due to psychological factors classified under 307.81 (Tension headache), Silberstein says.

This list of tension-type headache codes in the potential new 339.xx range means your internist's documentation needs to offer enough information to choose between tension and tension-type headaches.

For these primary headache disorders, choose 339.11 (episodic) for headaches experienced fewer than 15 days per month, and use 339.12 (chronic) for headaches that occur on more days than not for more than three months.

Post-traumatic headaches (PTH) represent another headache category you may see in ICD-9 2009. PTH can be part of post-concussion syndrome, but it does not have to be.

So if the internist documents PTH but doesn't document post-concussion syndrome, you may still be able to report one of the new PTH codes:

• 339.20 -- Post-traumatic headache, unspecified

• 339.21 -- Acute post-traumatic headache

• 339.22 -- Chronic post-traumatic headache.