Part B Insider (Multispecialty) Coding Alert

Plus: Know how to report these headaches under ICD-10.

When reporting a migraine, the first factors you should look for are the severity and length of time the patient has had the problem. For a chronic, continuing form of headache that isn’t responding to standard treatment, you turn to codes for intractable migraine. Then confirm if your physician is treating a status migrainosus.

Example 1: Your physician treats a migraine in a patient who had a headache for the past two days. The patient has a history of similar attacks that respond to the regular medication. Report ICD-9 code 346.10 (Migraine without aura, without mention of intractable migraine, without mention of status migrainosus). The ICD-10 code for the same will be G43.009 (Migraine without aura, not intractable, without status migrainosus).

Example 2: The physician treats a migraine that the patient complains of having for the last two days; the patient’s history indicates that the headaches are not typically effectively controlled by standard intervention. You confirm that this headache is intractable (i.e., it doesn’t typically respond to pills). You confirm this attack to be an intractable migraine without status migrainosus. You report ICD-9 code 346.11 (Migraine without aura, with intractable migraine, so stated, without mention of status migrainosus). The corresponding ICD-10 code is G43.019 (Migraine without aura, intractable, without status migrainosus).

Aura or no aura? You may report the presence or denial of an aura as the default code is 346.9x (Migraine unspecified).

Similarly, if you confirm that your physician is treating a status migrainosus, a debilitating headache lasting more than 72 hours, in a patient whose migraines were previously well-managed with traditional outpatient intervention, you report ICD-9 code 346.12 (Migraine without aura, without mention of intractable migraine with status migrainosus).

Under ICD-10 next year, you will turn to G43.001 (Migraine without aura, not intractable, with status migrainosus). When your physician treats a migraine that is both intractable and debilitating and lasts more than 72 hours, you report 346.13 (Migraine without aura, with intractable migraine, so stated, with status migrainosus) in ICD-9 and code G43.011 (Migraine without aura, intractable, with status migrainosus) under ICD-10.