Anesthesia Coding Alert

Red alert: ICD-9 plans more specific options for chronic migraines, status migrainosus and moreYou may have up to 30 new migraine codes in the ICD-9 2009 pipeline to help you with pain management coding.ICD-9 will expand the 346.xx (Migraine) coding series to its highest degree of specificity ever. Here's a handy rundown of the new migraine coding series that is bound to make your job a lot easier.The new deal: CMS recently released its preliminary ICD-9 2009 list, set to go into effect Oct. 1, 2008. The changes aren't official yet, but here's a sneak peek at how these proposed changes will affect your migraine coding.Watch for Fifth-Digit Options UpgradeYou'll have new and revised fifth-digit options for 346.xx. In 2008, you choose between 0 (Without mention of intractable migraine) and 1 (With intractable migraine, so stated).But in 2009, you'll choose among the following:• 0 -- Without mention of intractable migraine without mention of status migrainosus• 1 -- With intractable migraine, so stated, without mention of status migrainosus• 2 -- Without mention of intractable migraine with status migrainosus• 3 -- With intractable migraine, so stated, with status migrainosus.Benefit: These fifth-digit options will allow the provider to indicate the presence of status migrainosus, which is a prolonged migraine that increases the patient's stroke risk, says coding expert Jackie Miller, RHIA, CPC, senior coding consultant for Coding Strategies Inc. in Powder Springs, Ga.Match Documented Dx to Detailed 346.0x ListICD-9 2009 also plans changes for the codes you'll be adding those new fifth-digit options to, starting with 346.0x. According to ICD-9 2008, you use 346.0x (Classical migraine) to describe migraines with auras or migraines preceded or accompanied by transient focal neurological phenomena.The 2009 manual will also instruct you to report 346.0x for the following migraine types, says Stephen D. Silberstein, MD, FACP, past president of the American Headache Society, director of the Jefferson Headache Center and professor at Thomas Jefferson University Hospital in Philadelphia, in his presentation, "Headache Classification 2007" (www.cdc.gov/nchs/ppt/icd9/att1_headache_mar07.ppt):• classic migraine• basilar migraine• migraine-triggered seizures• migraine with acute-onset aura• migraine with aura without headache (migraine equivalents)• migraine with prolonged aura• migraine with typical aura• retinal migraine.Add 3 New Variants to 346.2xUntil now, 346.2x (Variants of migraine) was something of a catchall for other migraine types, ranging from cluster headaches to Horton's neuralgia.Watch documentation for clues: ICD-9 2009 will add that 346.2x includes the following migraine variants, Silberstein says:• cyclical vomiting• ophthalmoplegic migraine• periodic headache syndromes in child or adolescent.Hemiplegic, Menstrual Headaches Get Own CodesThe first new code ICD-9 2009 will add to the series is 346.3x (Hemiplegic migraine). Providers consider this rare migraine type one of the more severe forms. Symptoms include temporary paralysis -- hemiplegia -- or sensory changes on [...]