Revenue Cycle Insider

Question: Encounter notes indicate that a patient suffers from “hemiplegic migraine.” I’ve seen these codes in the ICD-10-CM book, but I’ve never used them. What are the characteristics of a hemiplegic migraine?

Idaho Subscriber

Answer: It’s not surprising that you haven’t coded for a hemiplegic migraine patient; the condition is among the rarer migraine types. But when a patient reports with the condition, however rare, the coder needs to be ready to roll.

In short, hemiplegic migraines temporarily cause weakness or paralysis on one side of the body, which can often resemble a stroke. The symptoms of a hemiplegic migraine include:

• Severe, throbbing pain, often on one side of the head
• A pins-and-needles feeling, often moving from the patient’s hand up their arm
• Numbness on one side of the body, which can include the patient’s arm, leg, and/or one side of their face
• Weakness or paralysis on one side of the body
• Loss of balance and coordination
• Visual aura, such as seeing zigzag lines, double vision, or blind spots
• Language difficulties, such as mixing words or trouble remembering a word
• Slurred speech
• Dizziness or vertigo
• Nausea and vomiting
• Extreme sensitivity to light, sound, and smell
• Confusion
• Decreased consciousness or coma

If the patient experiences one or more of these symptoms and the physician makes a final diagnosis of hemiplegic migraine, you’ll report the condition with a code from the G43.4- (Hemiplegic migraine) subcategory. Hemiplegic migraine might also be referred to as familial migraine or sporadic migraine. The ICD-10-CM codes go on to identify whether the migraine was intractable or not intractable (5^th character) and whether it was accompanied by status migrainosus (6^th character).

Chris Boucher, MS, CPC, Senior Development Editor, AAPC