Knowing what indicates an 'aura' could solidify code choice. Patients who report to a PM specialist for treatment of migraines aren't always easy to diagnose. Since ICD-10 came along with its greater specificity, getting just the right diagnosis for a patient's migraines has gotten tougher. Good news: All that hard work is beneficial to the patient, who can count on more focused and direct care with a more accurate migraine diagnosis. Check out this expert advice on some of the most common migraine terms, and how to apply them to your ICD-10 coding. Aura Often Marked by Blind Spots In order to report most of the migraine ICD-10 codes, you're going to have to have a handle on the definition of "aura." For coding purposes, a migraine with aura often contains visual disturbances, like seeing patterns or lights or losing vision, tunnel vision, etc., explains Cathy Satkus, CPC, coder at Harvard Family Physicians in Tulsa, Oklahoma. According to Yvonne Dillon, CPC, CEDC, director of emergency department services at Bill Dunbar and Associates, LLC in Indianapolis, Indiana, migraine auras refer to "specific nervous system symptoms that occur or begin approximately five to 20 minutes prior to the onset of the headache." Dillon says these symptoms can include, but are not limited to, the following: Best bet: If you see any of the above symptoms in the encounter notes, be sure to consider an aura diagnosis for your migraine patient. Paralysis Might Equal Hemiplegic Migraine If one of the symptoms of the patient's migraine is partial or temporary paralysis, then he might suffer from a hemiplegic migraine (G43.4-, [Hemiplegic migraine]). Dillon says that some of the classic symptoms of hemiplegic migraine include: Prep for Rare CI/Migraine Combo When the provider records a migraine with cerebral infarction (CI), you'll have to choose a code to represent the condition; for example, G43.61 (Persistent migraine aura with cerebral infarction, intractable). For diagnosis coding purposes, a migraine with cerebral infarction, or "migrainous infarction," refers to a migraine during which "a cerebral infarction occurs. This may cause a stroke in the patient," relays Dillon. Migraines with CI occur more commonly in patients who have migraine with aura as opposed to those without aura, she continues. Also, you'll need to report the CI along with the migraine code in this case. According to the notes below G43.6- (Persistent migraine aura with cerebral infarction), Code also the type of cerebral infarction (I63.-). Follow Specific Rules for Chronic Cases PM practices will also see their share of patients suffering from chronic migraines. When looking to ICD-10, you'll need to know several rules for coding chronic migraines in a patient. Before reporting a code for chronic migraine, such as G43.709 (Chronic migraine without aura, not intractable, without status migrainosus), be sure that the patient meets chronic migraine standards. According to Dillon, "chronic migraines are those that occur 15 or more days in a month within at least a three-month span without medication overuse." In addition, the chronic migraine patient must also experience two or more of the following symptoms eight or more days per month for at least three months: Confused? If you're unsure whether or not the operative notes support an ICD-10 code for chronic migraine, check with your payer before choosing a diagnosis.