Pediatric Coding Alert

Question: A co-worker says we can submit "headache" and "migraine" on the same claim, but I think that if the physician has established a migraine diagnosis, you can't code a headache. Who is correct?

Tennessee Subscriber

Answer: A migraine is a specific type of headache. Coding separately will depend on whether the provider uses the term "headache" as a sign/symptom of the migraine or if the patient has both a migraine and a separate, distinct headache. A "headache" is inherent in a diagnosis of "migraine" and would not be separately reportable.

ICD-9 guidelines direct us as to whether we report things separately: "Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification." Further instructions state, "Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present."

Tip: Remember that having a previous diagnosis of migraine doesn't mean you automatically report a migraine for future complaints. Every headache doesn't meet migraine level, so a diagnosis such as tension headache (339.1) or cluster headache (339.0) could sometimes be more appropriate.