Primary Care Coding Alert

Question: Our FP saw a patient who complained of migraine pain. After examining the patient, our physician believed the patient was trying to get a pain medication prescription. Which diagnosis should I report?


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Answer: Coding experts offer many suggestions for a diagnosis in this case, including V65.5 (Person with feared complaint in whom no diagnosis was made), 784.0 (Headache) or 346.9x (Migraine, unspecified)--if the physician actually diagnosed a headache or migraine. If your FP truly believes that the patient is faking the illness to obtain medication, go for the hard-hitting diagnosis: V65.2 (Person feigning illness).  

You should ask the physician which diagnosis to use if the documentation doesn't make it clear. The insurer may not pay for the visit because there was no condition that the physician actually treated. You should inform the patient that she might be financially liable for the visit if the insurer considers it a noncovered service.

Document it: If your physician is concerned that the patient is seeking drugs, he should note this in the patient's chart for future reference. Answers to You Be the Coder and Reader Questions reviewed by Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.