ED Coding and Reimbursement Alert

Question: I am having trouble navigating the new ICD-9 codes for migraines. My encounter notes state that the ED physician provided a level-three E/M for a patient who had an "intractable basilar migraine with status migrainosus." I know the right diagnosis code is in ICD-9 2009, but which one is it? Illinois Subscriber Answer: To represent the patient's migraine type, report 346.03 (Migraine with aura; with intractable migraine, so stated, with status migrainosus). For the ED service, use 99283 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of moderate complexity ...). ICD-9 2009 features upward of 30 new migraine codes, which means you must be a lot more specific when choosing a diagnosis code for your migraine claims. Base code: ICD-9 2009 calls for coders to use 346.0x (Migraine with aura) to represent basilar migraines. You should also use 346.0x for: - classic migraine - migraine proceeded or accompanied by transient focal neurological phenomena - 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. You-ll also have to select a fifth digit for this code based on whether or not status migrainosus is present. With 346.0x, choose from these fifth-digit options: - 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