Neurology & Pain Management Coding Alert

Our experts explain why 346.xx changes will cause no pain CMS recently released its preliminary ICD-9 2009 list, expanding the 346.xx series with about 30 new migraine codes for you. The new deal: The proposed changes are set to go into effect Oct. 1, 2008. Here's the lowdown on how these proposed changes will affect your migraine coding. Don't miss: You-ll have new and revised fifth-digit options for each of these codes: - 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. 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. 1. Let 346.xx Take a Load Off Your Mind There are changes in the works for 346.0x (Classical migraine). According to ICD-9 2008, you use 346.0x to describe migraines with auras or migraines preceded or accompanied by transient focal neurological phenomena. The revised 346.0x (Migraine with aura) will also include the following migraine types explicitly, 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" (http://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. 2. Even More Variety Added to 346.2x Until now, 346.2x (Variants of migraine) was a catchall for other migraine types. ICD-9 2009 will instruct you that 346.2x also includes the following migraine variants, Silberstein says: - cyclical vomiting - ophthalmoplegic migraine - periodic headache syndromes in child or adolescent. 3. Code 346.3x Helps With Hemiplegic Coding The first new preliminary code ICD-9 2009 adds 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 one side of the body, as well as dizziness or vision changes. This classification encompasses both familial and sporadic migraines, Silberstein says. 4. Menstrual Migraine Classification Eases Pain New possible coding subcategory 346.4x (Menstrual migraine) covers menstrually related migraines and pure menstrual migraines, Silberstein says. 5. Persistence Pays Off With 346.5x New ICD-9 code 346.5x (Persistent migraine aura without cerebral infarction) will give you several new options [...]