Neurology & Pain Management Coding Alert

Try your hand at looking up these signs and symptom equivalents.

Your pain management specialist or neurologist might often see patients who complain of headache or migraine-like symptoms. If understanding the boundaries between migraine headache signs and symptoms is an ongoing challenge, follow these pointers to pinpoint the appropriate migraine diagnosis. Then, take the next step by testing yourself on how the diagnosis will convert into ICD-10 codes.

Look at Symptoms Beyond the Surface

Even physicians do not have internationally accepted criteria for migraine-associated dizziness. When a patient who has migraine presents to the office with complaints of dizziness, usually, the physician would diagnose it by looking at symptoms for a migraine headache (346.9x), which include:

• unilateral throbbing pain lasting from four to 72 hours, along with nausea/vomiting (787.01);
• photophobia (368.13); and/or
• abnormal auditory perception (388.40).

 Additionally, patients often experience vertigo (780.4) when they have had migraine episodes with aura (346.0x) or without aura (346.1x).

The physician should also take a thorough history of the patient’s migraine. For instance, he should determine whether the dizziness occurred during a headache-free interval, or if it came with symptoms such as spontaneous rotational vertigo, motion sickness (994.6), and visual motor sensitivity.

Check Your Answers

For Challenge 1, you should report migraine headache (346.9x); unilateral throbbing pain lasting from four to 72 hours, along with nausea/vomiting (787.01), photophobia (368.13); and abnormal auditory perception (388.40).

The ICD-10 equivalents are G43.-- (Migraine), R11.2 (Nausea with vomiting, unspecified), H53.14- (Visual discomfort), and H93.2-- (Other abnormal auditory perceptions).

For Challenge 2, you should report vertigo (780.4); migraine episodes without aura (346.1x); migraine with aura (346.0x); and motion sickness (994.6).

The ICD-10 equivalents are R42 (Dizziness and giddiness), G43.0- (Migraine without aura), G43.1- (Migraine with aura), and T75.3xxA (Motion sickness, initial encounter).

Final reminder: You should only separately report any signs and symptoms that may be associated with migraines / headaches if the provider does not make any further definitive diagnosis or if your provider indicates that these signs and symptoms were not associated with migraines/headaches. Also note the reporting guidelines in ICD-10 for signs and symptoms, including this directive: “ICD-10-CM contains a number of combination codes that identify both the definitive diagnosis and common symptoms of that diagnosis. When using one of these combination codes, an additional code should not be assigned for the symptom.”