Neurology & Pain Management Coding Alert

Question: During an office evaluation and management (E/M) service for a new patient, the provider diagnoses ‘classical migraine.’ Total encounter time was 27 minutes and medical decision making (MDM) was low. How should I report this encounter?

Pennsylvania Subscriber

Answer: First, the E/M. Since you can report office/outpatient E/Ms by total encounter time or MDM, it behooves you choose time or MDM based on the resulting CPT^® code. If you code this encounter by total time, then you’d have to report 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.). If you report the encounter according to MDM, then you can report 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.).

As long as you’re sure that the MDM was low during the encounter, opt for the higher-level (and higher-paying) 99203.

Now, the ICD-10 coding. The description you give, of a classical migraine, is another term for migraine with aura; report these migraines with one of the following ICD-10 codes, depending on encounter specifics:

• G43.101 (Migraine with aura, not intractable, with status migrainosus)
• G43.109 (… not intractable, without status migrainosus)
• G43.111 (… intractable, with status migrainosus)
• G43.119 (… intractable, without status migrainosus)

Alternate term alert: In addition to “classical,” these terms are also synonymous with migraine with aura, according to ICD-10:

• Basilar migraine.
• Migraine equivalents.
• Migraine preceded or accompanied by transient focal neurological phenomena.
• Migraine triggered seizures.
• Migraine with acute-onset aura.
• Migraine with aura without headache (migraine equivalents).
• Migraine with prolonged aura.
• Migraine with typical aura.
• Retinal migraine.

Best bet: Always check with your provider, but look to the G43.1 code set for a possible diagnosis match when you see one of these terms in the notes describing a patient’s migraine.