Part B Insider (Multispecialty) Coding Alert

Published on Fri Oct 02, 2009 PDF

In some cases, the unspecified code may be your best option.

Question: A 46-year-old new patient presents to our practice with recurring headaches. She reports that the headaches started sporadically "about five weeks ago," increasing in frequency but decreasing in severity to the point that she was having mild to moderate headaches daily that she was treating with various over-thecounter headache medications.

Answer: Yes, if the physician cannot get a more specific diagnosis, the choice is 346.90 (Migraine, unspecified, without mention of  intractable migraine without mention of status migrainosus). So check the notes one more time for more details; if you find none, report the following:

• 96372 (Therapeutic, prophylactic,or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the Demerol injection

• J2175 (Injection, meperidine HCL, per 100mg) x 1 for the Demerol supply

• 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity ...) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99203 to represent the separate natures of the injection and the E/M.

• 346.90 appended to 96372, J2175, and 99203-25 to represent the patient's symptoms.