Most of the commonly used codes for headache comes under categories G43 and G44 which can be found in chapter 6 (diseases of nervous system-code range G00-G99) in ICD-10 CM manual.
Types of headache: Depending on the cause of headache it is divided as primary and secondary. Primary Head ache. This is due to any activity (physical or mental) which triggers the pain structures in head, not related to any underlying disease. Few examples below which are commonly found in medical record.
Migraine – Severe headache at one side of the head with light sensitivity and nausea.
Few examples below which are commonly found in medical record. Cluster headache – It is so called because it occurs in patterns or clusters. It is very severe, pain comes at one side of the head mostly around one eye. Migraine – Severe headache at one side of the head with light sensitivity and nausea.
From past 6 months it is happening for every period and lasts for 3 days. She states earlier she used to get abdominal pain during periods, though not every month. Today is her 2 nd day of period.
As per ICD coding guidelines routine signs and symptoms of a definitive diagnosis should not be coded separately. Hence if headache is mentioned in the medical record and if it is a common symptom of the diagnosis which we are coding (secondary headache),remember to avoid coding unspecified headache R51.9
Physician can diagnose the type of headache or the underlying cause depending on the area and severity of the pain and also from the history and physical exam. Based on these findings physician may do blood test, CT or MRI head, sinus X-ray, EEG or Spinal tap for further investigation. Coder needs to evaluate interpretation of these test results for more specific ICD code.
Chronic migraine does not have a direct entry in ICD-10 manual index. It should be coded as G43.709 (migraine, without aura, chronic)
Note: Coded G43.709 (chronic migraine without aura) though not mentioned as with or without aura as there is no specific index entry for migraine chronic directly.
Migraine occurs in 4 stages (though not all stages in everyone) – Prodrome, aura, attack, post-drome. Knowing the stages is important in assigning a case specific ICD code.
Sometimes severity of the pain can be very severe and can last for more than 2 days.
The type of pain can be throbbing at one side of the head associated with light sensitivity and nausea, vomiting.
Symptoms include, black dots, flashes of light, hallucination, unable to speak clearly, weakness or numbness on face or one side of the body, difficulty in talking.
Physician can diagnose migraine based on history, signs and symptoms. An MRI or CT of brain is done if feels any complications or difficulty to diagnose.
Rationale: Look in the ICD-10-CM Alphabetic Index for Headache. You can also find the code by going to Pain/head. There is no further description making R51 the correct code. Verify code selection in the Tabular List
Determine the main term which is headache. In the ICD-10-CM Alphabetic Index, look for Headache/migraine (type) (see also Migraine). In the same index look for Migraine (idiopathic)/without aura/chronic/not intractable/with status migrainosus directs you to code G43.701. Review the code in the Tabular List to verify the code accuracy.
Rationale: Look in the ICD-10-CM Alphabetic Index for Salpingitis/gonococcal (acute) (chronic) A54.24. Look for A54.24 in the Tabular List. You only need to report one code for this diagnosis. Under code N70 there is an Excludes1 instructional note that lists gonococcal infection (A54.24) which indicates that no codes from the N70 category should be reported for this diagnosis.
The main term is infarction. In the ICD-10-CM Alphabetic Index, look for Infarct, infarction/myocardium, myocardial (acute) (with stated duration of 4 weeks or less) I21.9. Refer to the Tabular List. This is the correct code, even though there is no stated duration in the question, because code I21.9 lists Myocardial infarction (acute) NOS under the code. Note: There is a category note for I21 to use additional code, if applicable, to identify exposure to, use of, dependence of tobacco, or status post tPA in another facility. This is coded if known.
The main term is ruptured. From the ICD-10-CM Alphabetic Index look for Rupture, ruptured/spleen/nontraumatic. You are referred to D73.5. Review the code in the Tabular List to verify the code accuracy. The diagnosis documents the rupture of the spleen was not due an injury, also called nontraumatic. Splenic rupture, nontraumatic is listed as an inclusion term under D73.5.
Look for Syncope in the ICD-10-CM Alphabetic Index. You are referred to R55. Review the code in the Tabular List to verify the code accuracy.
R10.13The main term is pain. In the ICD-10-CM Alphabetic Index, look for Pain/epigastric, epigastrium. You are referred to R10.13. Review the code in the Tabular List to verify the code accuracy.
These are reported with codes in category G44. Conditions that may cause or be associated with migraines should be reported additionally. Migraines can represent an adverse effect of some drugs; drugs that are known to trigger migraines include nitroglycerine and oral contraceptives.
So a migraine without aura, not intractable, without status migrainosus, diagnosed as an adverse effect of nitroglycerin (initial visit) would require two codes: G43.009 for the migraine and T46.3x5A Adverse effect of coronary vasodilators. Migraines with aura rarely may be complicated by a seizure.
Status migrainosus refers to a migraine that has lasted more than 72 hours. It should be noted that lower-half migraine and migrainous neuralgia are terms that refer not to migraines in category G43, but to cluster headache syndrome. These are reported with codes in category G44.
Migraine codes have fifth characters that further differentiate the condition as not intractable (0) or intractable (1). When reviewing documentation, the following terms are considered to be equivalent to intractable: pharmacoresistant, pharmacologically resistant, treatment resistant, refractory, medically refactory, and poorly controlled. And migraine codes, except codes for some migraine variants (G43.A-, G43.B-, G43.C-, and G43.D-), also can have a sixth character that identifies the migraine as occurring with status migrainosus (1) or without status migrainosus (9). Status migrainosus refers to a migraine that has lasted more than 72 hours.
Migraine headaches frequently are accompanied by autonomic nervous system symptoms, such as nausea, vomiting, and sensitivity to light and/or sound.
A migraine is a common neurological disorder that often manifests as a serious headache. Usually unilateral and pulsating in nature, the headache results from abnormal brain activity along nerve pathways and brain chemical (neurotransmitter) changes.
Migraine variants usually affect children and young adults. The neurological disorder also can result in symptoms other than a headache. These symptoms can include prolonged visual aura, atypical auras, confusion, abdominal pain, cyclic vomiting, vertigo, hemiplegia/hemiparesis and dysarthria (speech problems).