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migraine dx codes

  1. #1
    Location
    Savannah, GA
    Posts
    33
    Angry migraine dx codes
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    If a physician determines that a patient has migraines they will choose dx code 346.00 which is the only thing I come up with as well. I am having issues with patients where their insurance is not covering the visit stating it is a psych disorder. This code is not in the mental disorders section so I don't understand what the problem is... Should the physician be using a different dx? Is anyone else having this problem?
    Last edited by jnieto625; 05-27-2010 at 09:46 AM. Reason: Correction

  2. Default
    346.00 is correct for your basic migraine. Is this one specific payer that is denying as psych? If so, it appears they have a bad edit in their system.

    You have 2 choices, call the Payer Rep and have them explain why they are denying a migraine as a psych condition and ask that they fix their edit. Or you can send in the chart note and appeal. If you do the 2nd make sure the note you send in supports the E&M level your billed or they will "correct the E&M level based on documentation"

  3. #3
    Location
    Savannah, GA
    Posts
    33
    Default
    Thanks so much for responding! It is one specific payor that always does this whenever we submit a dx for migraines and/or tension headaches. I think I'm going to try and and get it resolved with our rep so that I don't have to keep appealing.

  4. #4
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by jdelgado625 View Post
    Thanks so much for responding! It is one specific payor that always does this whenever we submit a dx for migraines and/or tension headaches. I think I'm going to try and and get it resolved with our rep so that I don't have to keep appealing.
    They probably do have a problem with their edits on the migraines. On the tension headaches, if you use 307.81, that will hit the psych edits because it is in the range, and says psychological factors. Thank goodness they gave us new tension headache codes, 339.1X. When I worked for a payor, I used to argue with my bosses that tension headaches shouldn't hit the psych benefit, but it was like hitting my head against a brick wall.

    Good luck with your payor!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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