Neurology & Pain Management Coding Alert

Question: We recently had a patient complaining that she had migraine pain. When our neurologist examined the patient, though, she suspected that the patient was actually trying to illegally obtain a pain medication prescription. I still need to code for this; what should I report for the diagnosis? California Subscriber Answer: You should code according to the physician's note. If she stated that she believes the patient isn't actually suffering from the condition you saw her for, you should report V65.2 (Person feigning illness). Talk to your neurologist to decide whether she (and you) would be more comfortable with a more typical coding choice. If your neurologist actually diagnosed a migraine, you can report a generic headache code such as 784.0 (Headache) or 346.9x (Migraine, unspecified). Make a note: If your physician believes that the patient is looking for an illegal prescription, you may want to recommend flagging the patient's chart for future reference. -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside.