Internal Medicine Coding Alert
Remember 5th Digit on New Migraine ICD-9s
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Question: I am having trouble navigating the new ICD-9 codes for migraines. My encounter notes state that the internist treated 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). ICD-9 2009 features upward of 30 new migraine codes -- so 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.
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