Neurology & Pain Management Coding Alert

Migraines are of several different types, affect patients differently.

A patient reporting to your practice for treatment of a migraine has already experienced a pretty grueling episode. Make sure you don’t get a headache yourself when trying to pick the perfect ICD-10 code for your patient’s condition.

Take a look at the terms you might encounter when considering your most common migraine diagnosis, and remember to refer to it when you have questions about your migraine patients’ diagnoses.

Aura Equals Code Selection G43.1--

The first question you’ll need to ask about the migraine is if it was accompanied by aura. When a patient experiences aura with migraine report G43.1- (Migraine with aura); if no aura is present, select G43.0- (Migraine without aura) instead.

Explanation: “The term ‘aura’ when being used with a migraine are specific nervous system symptoms that occur or begin approximately five to 20 minutes prior to the onset of the headache,” says Yvonne Bouvier, CPC, CEDC, at Degraff Memorial in Indianapolis. These symptoms can include, but are not limited to, the following:

• Blind spots within the patient’s visual field.
• Seeing a “zigzag” pattern.
• Blindness affecting half the patient’s visual field in either both or one eye.
• Experiencing visual hallucinations.
• Seeing flashing lights.
• Feeling pins and needles sensation in arms or legs.
• Difficulty speaking.

These visual disturbances are the most common form of aura, but this list shows there are other ways a migraine aura can manifest itself,

When considering migraine diagnoses, “I look for notes indicating visual disturbances, like seeing patterns or lights or losing vision, tunnel vision, etc.,” says Cathy Satkus, CPC, coder at Harvard Family Physicians in Tulsa, Oklahoma.

Paralysis Means Hemiplegic Migraine

If the notes indicate that a patient is suffering from hemiplegic migraine, you’ll instead start with a base code of G43.4- (Hemiplegic migraine).

These are migraines accompanied by weakness or paralysis on one side of the body. “The weakness/ paralysis is considered a motor aura and usually coincides with other forms of aura that could impair vision, speech or sensation. These migraines are often confused with a stroke,” explains Satkus.

Patients suffering from hemiplegic migraine might also suffer confusion of difficulty speaking, Bouvier adds.

Stroke Can Accompany Migraine

In some extreme cases, the migraine will be accompanied by a cerebral infraction (CI). When this occurs, it’s a migraine with cerebral infarction, which you’d code with G43.6- (Persistent migraine aura with cerebral infarction).

“A migraine with CI, or migrainous infarction, refers to when a cerebral infarction occurs during or at the time of a typical migraine. This may cause a stroke in the patient. These are rare and occur more commonly in patients who have migraine with aura as opposed to those without aura,” explains Bouvier.

To code a migraine with CI, a migraine with aura must occur and “last for at least one hour, if not longer. Additional symptoms can include diplopia, dysarthria, imbalance,” according to Satkus. The infarction also has to be confirmed by imaging in order to report G43.6-.

Exception: The “persistent aura” described above is also possible in a migraine patient who isn’t suffering a CI; when this occurs, you’ll opt for G43.5- (Persistent migraine aura without cerebral infarction).

Extreme Frequency Marks Chronic Migraine

For patients who get a lot of migraines, you’ll want to consider whether or not they suffer from chronic migraine, which you’d report with G43.7- (Chronic migraine without aura).

Chronic migraine sufferers make up about 15 percent of total migraine patients, according to the Mayo Clinic. And with those headaches come some pretty strict guidelines for a patient to qualify as a chronic migraine sufferer. “Chronic migraines are those that occur 15 or more days in a month within at least a three-month span without medication overuse,” explains Bouvier.

In addition to the “15 migraine days in a month” stipulation, chronic migraine sufferers must also have experienced two or more of the following symptoms eight or more days per month for at least three months:

• Headaches are moderate to severe.
• Each headache lasts four hours or more.
• Headaches occur only on one side of patient’s head.
• Headaches cause pulsating pain.
• Headaches are aggravated by routine physical activity.
• Headaches cause vomiting, nausea, or both.
• Headaches are coupled with sensitivity to light and sound.