Pain Management Coding Alert

Question: Notes indicate that the clinician performed a bilateral Botox A (onabotulinumtoxinA) injection for an established patient suffering from chronic migraine without aura; the provider performed the injection via chemodenervation, and used 0.75 units of Botox A. How should I code this encounter, and what are the definitions, for coding purposes, of "chronic" and "aura"?

New Mexico Subscriber

Answer: First, we'll tackle the coding question. Then, we can move on to the migraine definitions you asked about.

On the claim, you should report 64615 (Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [eg, for chronic migraine]) for the injection, along with supply code J0585 (Injection, onabotulinumtoxinA, 1 unit).

As for the diagnosis code, you'll need to go back to the notes and get more info on the patient's specific condition. Then, you'll choose one of the following diagnosis codes for the patient's migraines:

• G43.701, Chronic migraine without aura, not intractable, with status migrainosus
• G43.709, Chronic migraine without aura, not intractable, without status migrainosus
• G43.711, Chronic migraine without aura, intractable, with status migrainosus
• G43.719, Chronic migraine without aura, intractable, without status migrainosus

Definitions: Check out these brief definitions for migraine terms that are key to understanding the condition's varied diagnoses:

Aura: When describing a migraine, aura refers to specific nervous system symptoms that occur or begin approximately five to 20 minutes prior to the onset of the headache. These symptoms can include, but are not limited to, a patient:

• Experiencing blind spots in her visual field,
• Seeing a "zigzag" pattern,
• Experiencing blindness affecting the visual field in either one or both eyes,
• Having visual hallucinations,
• Seeing flashing lights,
• Experiencing a "pins and needles" sensation in the extremities, or
• Having difficulty speaking.

Chronic: Chronic migraines occur when the patient suffers from a headache at least 15 days in a month with for three months or more. Of those 15 days, eight of those headaches need to meet the criteria for a migraine (e.g., the headache lasts for four hours or more; causes moderate to severe pain; is exacerbated by physical activity; typically affects one side of the head and causes throbbing sensation; and is often accompanied by nausea/vomiting).

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