Neurology & Pain Management Coding Alert

Question: During a level-three office evaluation and management (E/M) service for a new patient, the provider diagnosed the patient with “migraine w/prodrome, no status migrainosus.” What is migraine with prodrome, and how do I code this encounter?

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Answer: The term “prodrome” could throw you, but it is merely a synonym for aura. So on your claim, you should append G43.101 (Migraine with aura, not intractable, with status migrainosus) to 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.) for this claim.

“Migraine with aura” is a relatively new name for the less common type of migraine headache. Aura refers to feelings and symptoms you notice shortly before the headache begins. Symptoms of aura might include:

• Blind spots or scotomas
• Blindness in half of your visual field in one or both eyes (hemianopsia)
• Seeing zigzag patterns (fortification spectra)
• Seeing flashing lights (scintilla)
• Feeling prickling skin (paresthesia)
• Weakness
• Seeing things that aren’t really there (hallucinations)

Head’s up: Prodrome isn’t the only synonym for aura. You’ll want to look at migraine with aura ICD-10 codes if you see any of the following terms in the provider’s notes:

• Basilar migraine
• Classical 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.