Anesthesia Coding Alert

Bonus: This map makes 2012 prep a piece of cake.

Now that headache classifications, ICD-9, and ICD-10 are aligned, updating your diagnoses shouldnt be as much of a pain provided you have the lowdown on what separates the 339 codes.

You can say goodbye to outmoded terminology, no epidemiology, and misclassification. The International Headache Society (IHS) published its revised International Headache Classification system (ICHD-2) in 2004, but prior ICD-9 codes didnt align with the system. Now, ICD-9 and the ICHD-2 are on the same page, which is good news for your practice, now and in the future, since ICD-10 descriptors map to ICHD-2.

Headache pain is the single largest factor in work absenteeism as well as total expenditures for healthcare costs, says Marvel Hammer, RN, CPC, CCS-P, PCS,ACS-PM, CHCO, owner of MJH Consulting in Denver. Being up to speed on proper ICD-9 headache codes is crucial to your bottom line.

These clues help you differentiate between two new 2009 ICD-9 primary headache diagnoses.

Welcome 6 New Headache Subcategories

ICD-9 brought providers a whole new category this year: 339, Hammer says. This is a brand-new category in the Diseases of Nervous System and Sense Organs chapter.

Six new subcategories have been created to give you more specific headache codes to work with and choose from. The new fourth digit subcategories include:

" 339.0x -- Cluster headaches and other trigeminal automatic cephalgias (TACs)

" 339.1x -- Tension type headaches (TTH)

" 339.2x -- Post-traumatic headache

" 339.3x -- Drug induced headache

" 339.4x -- Complicated headache syndromes

" 339.8x -- Other headache syndromes.

Warning: Category 339 excludes headaches NOS, migraines, and headaches due to lumbar puncture. If your physician continues to document only Patient has a headache, you will still have to go to 784.0 (Headache).

Count These Syndromes Under 339.0x

You might overlook using 339.0x if you cant ID a TAC. Trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes all marked by headache and associated autonomic features, says Todd D.Rozen, MD, of the Michigan Head-Pain and Neurological Institute in Ann Arbor, Mich.

Look for these syndromes that all fall under 339.0x.The TACs include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome, Rozen says.

339.00-339.02 Based on Frequency, Duration

When reporting a cluster headache, which is the most severe primary headache, determine the syndromes time zone (for vocab hints, see For Accurate Headache Dx,Look at Pathology, Timing on page 51). This type of unilateral headache tends to occur in clusters or in a series which lasts from several weeks to several months, separated by remissions lasting from months to years.

Here are the frequency and duration traits characteristic of the three new 339.0x codes:

" 339.00 -- Cluster headache syndrome, unspecified, which includes cluster headache NOS, ciliary neuralgia, histamine cephalgia, lower half migraine, and migrainous neuralgia.

" 339.01 -- Episodic cluster headache. These are attacks occurring in periods lasting seven days to one full year, but are separated by pain-free periods lasting a month or more. ICD-10 code: G44.01x.

" 339.02 -- Chronic cluster headache. These occur for more than one year without remission, or remissions lasting less than a month. ICD-10 code: G44.02x.

Look at Pain/Pain-Free Length With 339.0x

Headaches with similarities to cluster headaches in signs and symptoms but which are shorter-lasting, more frequent, and respond absolutely to treatment with Indomethacin are called paroxysmal hemicranias (339.03,339.04). The first term refers to the pains sudden recurrence or intensification; the second term refers to the fact that it affects only one side of the head.

Assign the appropriate fifth digit by zooming in on how long the attacks last and how much pain-free time there is. Youll use either:

" 339.03 -- Episodic paroxysmal hemicrania (including NOS). These headache attacks occur in periods lasting seven days to one year separated by pain-free periods lasting equal to or greater than one month, ICD-10 code: G44.03x.

" 339.04 -- Chronic paroxysmal hemicrania (occurs for more than one year without remission, or with remissions lasting less than one month). ICD-10 code: G44.04x.

Classify Short-Lasting Attacks Under 1 Code

Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) has one new code: 339.05. The ICD-10 code will be G44.05x.

A SUNCT headache typically lasts from five seconds to four minutes but may occur with a frequency of three to 200 times per day. The term neuralgiform means it resembles or has the characteristics of neuralgia.

Pinpoint Frequency for Tension Fifth Digit

Youll probably use 339.1x a lot. Tension type headaches are the most common primary headache, Hammer says. Patients often describe these headaches as bilateral with mild to moderate intensity and a pressing,tightening, and/or band-like sensation. Look at how

frequently these headaches occur to assign:

" 339.11 -- Episodic tension type headache. These occur randomly, and are often the result of stress, anxiety,fatigue, or anger. ICD-10 code: G44.20x.

" 339.12 -- Chronic tension type headache. This diagnosis follows the ICHD-2 definition of chronic in that headaches occur more than 15 days per month on average for more than three months. ICD-10 code: G44.22x.