Neurology & Pain Management Coding Alert

Here’s why you’ll need to know intractable, status migrainosus definitions.

Migraines are a whole lot of diagnosis codes for a single condition. But it’s such a headache to get the proper ICD-10 code for migraine patients for good reason: there are a lot of variables that make up a migraine, and every patient can experience them differently.

Once you get the correct ICD-10 code, it will focus the provider’s care regimen and, hopefully, help to staunch the stream of migraines for the patient. So it’s vital to provide as detailed a diagnosis as possible for each patient.

Help’s here: Last month, we focused on the first four characters of migraine diagnoses, and how you could differentiate among the different codes. Now, we’ll check out the fifth and sixth character options in migraine codes, what they mean, and how you should apply them to your coding.

‘Intractable’ Headaches Resist Treatment

Many of the codes in the G43 (Migraine) code set spell out whether a migraine is “intractable” or “not tractable.” These are two different terms, despite how similarly they are worded.

“Intractable headache is ‘doctor speak’ for that headache that just doesn’t seem to go away, not matter what you and your doctor do,” explains Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania. “Regardless of the cause, it is a relentless, seemingly untreatable headache. Migraine codes have fifth characters that further differentiate the condition as not intractable [0] or intractable [1].”

There are several different types of intractable migraines in ICD-10, including G43.019 (Migraine without aura, intractable, without status migrainosus) and G43.719 (Chronic migraine without aura, intractable, without status migrainosus). Conversely, there are codes for migraines that are not intractable as well; this means that the headaches respond to treatment at some point. The not intractable migraine codes include G43.509 (Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus) and G43.709 (Chronic migraine without aura, not intractable, without status migrainosus).

Pro tip: “When reviewing documentation, the following terms are considered to be equivalent to intractable: pharmacoresistant, pharmacologically resistant, treatment resistant, refractory, medically refractory, and poorly controlled,” according to Falbo.

Use Status Migrainosus for Exceedingly Long Migraines

Some migraine codes also have a sixth character that identifies the migraine as occurring with status migrainosus (1) or without status migrainosus (9). Codes that mention status migrainosus include G43.101 (Migraine with aura, not intractable, with status migrainosus) and G43.711 (Chronic migraine without aura, intractable, with status migrainosus). Codes that explicitly exclude status migrainosus include G43.119 (Migraine with aura, intractable, without status migrainosus) and G43.619 (Persistent migraine aura with cerebral infarction, intractable, without status migrainosus).

Status migrainosus refers to a migraine that has lasted more than 72 hours, explains Falbo. The patient might also experience other symptoms over the course of the dayslong headache, including:

• Sensation of sparkling lights or other vision changes (aura),
• Nausea and vomiting,
• Difficulty thinking properly,
• Dehydration, and
• Fatigue due to sleep loss.