Pain Management Coding Alert

Here's what defines an intractable migraine.

There is language in the ICD-10 book that can throw unprepared coders for a loop, especially when it comes to the intricacies of migraine diagnosis coding.

Why? There are terms, and guidelines, governing these terms that are more specific than for most conditions in the ICD-10 manual.

Don't worry, though. We've got you covered with even more migraine diagnosis terminology - in the form of this FAQ - from Mary I. Falbo, MBA, CPC, president and CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Q: For diagnosis coding purposes, what is an "intractable" migraine?

"Intractable headache is 'doctor speak' for that headache that just doesn't seem to go away, no matter what you and your doctor do," explains Falbo. The intractable headache is often associated with migraines, but it could also be "another kind of headache, or a combination of two or more different headache types; but regardless of the cause, [intractable] is a relentless, seemingly untreatable headache."

Q: What are some of the potential symptoms that might indicate a patient with an "intractable" migraine?

A: "When reviewing documentation, the following terms are considered to be equivalent to intractable: pharmacoresistant, pharmacologically resistant, treatment resistant, refractory, medically refractory, and poorly controlled," explains Falbo.

Q: What is 'status migrainosus'?

A: A patient who suffers from migraine with status migrainosus will require a diagnosis code reflecting that condition, such as G43.611 (Persistent migraine aura with cerebral infarction, intractable, with status migrainosus).

Rundown: "The symptoms of status migrainosus are similar to symptoms of a typical migraine," says Falbo. Along with pain in the head, common symptomsinclude:

• Sensation of sparkling lights or other vision changes;
• Nausea and vomiting; and
• Difficulty thinking properly.

Because status migrainosus lasts for at least three days, prolonged vomiting and pain can lead to dehydration and fatigue due to sleep loss, Falbo continues.

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