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Medical Billing for Migraine Patients With ICD-10 Coding

February 26, 2013

Neurology billing, Migraine BillingNeurology billing, primary care billing, and emergency room billing are about to become a bit more complicated when patients present a migraine. ICD-10 billing presents a number of challenges to medical coders and billers. The new methodology will require even greater specificity when it comes to assigning codes to healthcare claims, and will have to be supported by the available documentation. 

Diagnosis codes used commonly by outpatient neurology practices tend to fall within the 320-389 range of ICD-9-CM, Diseases of the Nervous System and Sense Organs. Migraines are coded 346, with the actual diagnosis code including five characters. For instance, a patient presenting with an intractable migraine without an aura and without mention of migrainosus, is assigned the code 346.11 on the CMS-1500 claim form. Under ICD-10 methodology, diseases of the nervous system are described by the codes contained between G00 and G99.

When a patient presents with a migraine that needs to be translated into ICD-10 diagnosis code, a total of six characters are needed to reach the greatest degree of specificity in order to create a clean healthcare claim. Migraines fall under the G40-G47 subset of ICD-10-CM codes, Episodic and paroxysmal disorders. By understanding the underlying logic of how ICD-10 is arranged, it is expected that less time will be spent cross-referencing the alphabetic and numeric indices.

Under ICD-10 there are 44 codes dedicated to describing various types of migraines. G43 is used to indicate that the patient was treated for migraine, but this code requires three additional characters to report payable diagnostic information. Each additional character builds on the placeholder before it until the sequence of information provides a complete picture of the patient’s medical condition. G43.0 is a migraine without aura. Adding a 1 to this code indicates an intractible migraine without aura. The final, sixth character is used to indicate the presence of status migrainosus — if a patient is diagnosed with an intractable migraine without aura without status migrainosus, the correct code under ICD-10 is G43.019. 

After the transition to ICD-10-CM coding, a coder or medical auditor will review the available documentation in the patient’s medical record in an even more systematic manner in order to come up with the most accurate codes. Less will be left to individual interpretation.

Though the implementation date for ICD-10 is scheduled to occur on October 1, 2014, smart medical practices are preparing now for the change. It is anticipated that many outpatient practices will suffer from an interruption in cash flow due to faulty coding under the new methodology. There is no reason for this to happen. At M-Scribe Technologies, we are reviewing the pertinent issues that will affect the crossover. Our certified medical coders and billers are fluent in the language and concepts of ICD-10. Our documentationists are prepared to make recommendations in current documentation standards, and to help “tighten them up” for ICD-10.  

Internal billing and coding audits prior to ICD-10 implementation will ensure compliance with future guidelines, when it is needed. Practices partner with M-Scribe’s introductory and ongoing refresher training while their claims are posted and reconciled in real time. Different medical specialties will have different needs, but they all require submitting clean healthcare claims.

Working with a professional medical billing company ensures that claims meet the industry’s exacting standards whether the diagnosis codes are ICD-9 or ICD-10. The foundation of accurate claims, timely reimbursement, and minimal denials/appeals is the goal now, and it will be the goal in the future.  Start now!


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