Neurology & Pain Management Coding Alert

Question: During a level-four office evaluation and management (E/M) service for a new patient, the provider diagnoses “histamine cephalitis, intract” This diagnosis has me stumped. How should I report this encounter?

Kentucky Subscriber

Answer: This is a diagnosis code that requires some digging if you aren’t familiar with synonyms for cluster headaches. You’ll code histamine cephalitis with a code from the G44.0- (Cluster headache syndrome, unspecified) code set. You’d also be choosing from the G44.0- code set if you see any of the following conditions described in the notes:

• Ciliary neuralgia
• Cluster headache NOS
• Lower half migraine
• Migrainosus neuralgia

Coding: For this claim, you’ll need to go to the 6th character with your ICD-10 code. Since the notes indicate that the headache was “intract” (intractable), you’ll append G44.001 (Cluster headache syndrome, unspecified, intractable) to 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) for this claim.