Otolaryngology Coding Alert

Try your hand at looking up these signs and symptom equivalents.

With ICD-10 looming in the near future — as in, next year — you need to start applying your otolaryngology diagnosis coding concepts to ICD-10. For instance, do you have a hard time telling the boundaries between migraine headache signs and symptoms? Pinpoint the appropriate migraine diagnosis using these pointers. Then, take the next step by converting these codes into ICD-10.

Keep in mind: If you’re an AAPC certified coder, you will have to take an ICD-10 proficiency examination, beginning October 1, 2013 (one year before implementation of ICD-10) and ending September 30, 2015 (one year after implementation). “It will measure your understanding of ICD-10-CM format and structure, groupings and categories of codes, ICD-10-CM official guidelines, and coding concepts,” the AAPC ICD-10 FAQ states (URL: http://www.aapc.com/icd-10/faq.aspx#pro … assessment). 

Remember, Symptoms Tell A Deeper Story

Even physicians do not have internationally accepted criteria for migraine-associated dizziness. When a patient who has migraine presents to the office with complaints of dizziness, usually, the otolaryngologist would diagnose it by looking at symptoms for a migraine headache, which include:

·         unilateral throbbing pain lasting from four to 72 hours, along with nausea/vomiting;

·         photophobia; and/or

·         abnormal auditory perception.

Additionally, vertigo takes place often in patients who have had migraine episodes without aura (346.1x), but it can also occur in migraine with aura..

The physician should also take a thorough history of the patient’s migraine. For instance, he should determine if the dizziness had occurred during a headache-free interval, or if it came with symptoms such as spontaneous rotational vertigo, motion sickness, and visual motor sensitivity.

Check Your Answers

For Challenge 1, you should report migraine headache (346.9x); unilateral throbbing pain lasting from four to 72 hours, along with nausea/vomiting (787.01), photophobia (368.13); and abnormal auditory perception (388.40).

The ICD-10 equivalents are G43.-- (Migraine), R11.2 (Nausea with vomiting, unspecified),

H53.14- (Visual discomfort), and H93.2-- (Temporary auditory threshold shift).

For Challenge 2, you should report vertigo (780.4); migraine episodes without aura (346.1x); migraine with aura (346.0x); and motion sickness (994.6).

The ICD-10 equivalents are R42 (Dizziness and giddiness), G43.0- (Migraine without aura), G43.1- (Migraine with aura), and T75.3xxA (Motion sickness, initial encounter).