Neurology & Pain Management Coding Alert

Coding for sex-associated headaches may not be as simple as it seems. Beyond sexual activity, you should consider other factors. Read further to get acquainted with this uncommon condition.

When coding for sex headaches, ICD-9 offers 339.82 (Headache associated with sexual activity), says Kristie Star, CPC, coding and compliance specialist for Wheaton Franciscan Healthcare in Milwaukee.

Name game: You might see a variety of terms in your neurologist's documentation that all boil down to sex  headache. A sex headache is precipitated by sexual activity, usually starting as a dull bilateral ache as sexual excitement increases and suddenly becoming intense at orgasm, in the absence of any intracranial disorder, according to the International Headache Society's International Classification of Headache Disorders-2 definition. Look for these other names: benign sex headache, coital cephalgia, benign vascular sexual headache, and sexual headache.

Code 339.82 also includes preorgasmic and orgasmic headaches. Although the characteristics of the two are quite different, it matters little to ICD-9, as it does not distinguish between the two.

Preorgasmic headache is described as a dull ache in the head and neck brought on by sexual activity and increasing in intensity with the increase in sexual excitement. On the other hand, orgasmic headache is a sudden, severe onset of explosive headache pain occurring at the time of orgasm. Both conditions assert that no other disorder is present that could account for these symptoms.

Looking for a code for a postcoital headache? ICD-9 makes no mention of postcoital (immediately after sex) headache. The term is even absent from the index. The best bet is to use 784.0 (Headache). Moreover,  medical literature explains that these types of headaches are more often due to vigorous sexual activity rather than for any other cause.