Neurology & Pain Management Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: We get denials from Medicare when we use ICD-9 diagnosis 346.8 (moebius/ophthlamaplegic migraine). Is there some other code to use? Do we need to go to the fifth digit on the code?

North Carolina Subscriber


Answer: According to ICD-9, in the Tabular Listing, code 346 (migraine) requires the use of a fifth digit, says Catherine A. Brink, CMM, CPC, president of Healthcare Resources Management, Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices. Code 346.8 (other forms of migraine) should have a fifth digit of 0 or 1.

Code 346.80 is for other forms of migraine that are not intractable (no mention of resistance to relief). Code 346.81 is for other forms of migraine with intractable migraine resistant to relief from medication. The Health Care Financing Administrations (HCFA) ICD-9 diagnosis coding guidelines indicate to choose the code that is to the highest degree of specificity allowed by the diagnostic information provided in the documentation. Coders should choose the appropriate fifth digit based on whether the migraine in question did or did not respond to medication. This means if a three-digit category is subdivided into fourth and fifth digits, you must use the ICD-9 code that has a fourth and/or fifth digit.

Most ICD-9 manuals have color-coded illustrated dots in red that mean additional digits required or a yellow diamond nonspecific code. Code 346.8 has both of these illustrations, which advises use of a 5th digit. Medicare usually denies payment with nonspecific diagnoses.