Radiology Coding Alert

Unlike ICD-9, vascular headaches get their own codes in the new code set.

When ICD-9 becomes ICD-10 in 2013, you will not always have a simple one-to-one relationship between old codes and the new ones. Often, you'll have more options that may require tweaking the way your physician documents a service and the way a coder reports it.

Consider this: Patients often present for imaging with the order indicating "headache." If the radiologist doesn't document a definitive diagnosis or relevant findings based on the exam, the most appropriate code to explain the reason for the test is 784.0 (Headache).

According to the ICD-9 2011 index, 784.0 is a code to consider (unless you find something more appropriate in the tabular) for headache; daily, chronic headache; nasal septum headache; and vascular headache.

ICD-10 difference: Under ICD-10 2011, your go-to code for "headache" will be R51 (Headache). According to the ICD- 10 index, R51, like 784.0, is a code to consider for headache; chronic daily headache; and nasal septum headache.

But take note that under ICD-10, vascular headaches are coded to G44.10 (Vascular headache, not elsewhere classified) and G44.11 (Vascular headache, not elsewhere classified, not intractable). "Intractable" means the pain is not easily managed or relieved, so "not intractable" means the pain is easily controlled.

Coder tips: Instead of relying on 784.0 as your catchall headache code, under ICD-10 you will use R51 to cover most headaches. But you'll also need to examine your physician's documentation to determine whether theheadache was diagnosed as "vascular." If so, look to the G44.1- codes instead.

Remember: When ICD-10 goes into effect on Oct. 1, 2013, you should apply the codes and official guidelines in effect at that time (or more specifically, always use the codes and guidelines effective for the relevant date of service). Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.