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Medical Coding News Archives

Migraine Coding for 2009

September 9, 2008:

This year 331 new ICD-9-M codes become effective October 1, 2008. Of those, 30 cover the numerous variations of headaches and migraines. One thing to note is there will be new and revised fifth-digit options for these new codes. These fifth-digit options will allow the provider to indicate the presence of status migrainosus, which is an acute migraine headache that lasts 72 hours or longer. These fifth digits should be used with all of the codes in the 346 section. Below are the definitions of the fifth-digit:

0 -- Without mention of intractable migraine without mention of status migrainosus

1 -- With intractable migraine, so stated, without mention of status migrainosus

2 -- Without mention of intractable migraine with status migrainosus

3 -- With intractable migraine, so stated, with status migrainosus

The 346.xx series of ICD-9-M include revisions as well as a new code. 

The revised 346.0x (Migraine with aura) will now include several migraine types such as:

  • Basilar migraine
  • Classic migraine
  • Migraine-triggered seizures
  • Migraine with acute-onset aura
  • Migraine with aura without headache (migraine equivalents)
  • Migraine with prolonged aura
  • Migraine with typical aura
  • Retinal migraine

The revised 346.2x (Variants of migraine, not elsewhere classified) will include the following migraine variants:

  • Abdominal migraine
  • Cyclical vomiting associated with migraine
  • Ophthalmoplegic migraine
  • Periodic headache syndromes in child or adolescent

Code 346.3x is a new code to the series (Hemiplegic migraine). This type of migraine is considered rare but the most severe. Symptoms include transient hemiplegia or sensory changes on one side of the body, as well as dizziness or vision changes.

Code 346.4x (Menstrual migraine) covers menstrually related migraines and pure menstrual migraines.

Code 346.5x (Persistent migraine aura without cerebral infarction) will give you more accurate options when coding for persistent migraines.  

Code 346.6x (Persistent migraine aura with cerebral infarction). Cerebral infarction must be documented by the physician.

Code 346.7x (Chronic migraine without aura) brings new coding possibilities for chronic migraines. This code includes transformed migraine without aura.

A transformed migraine is a migraine that started with episodic migraine attacks. These attacks then increase in frequency and change characteristics, resulting in less severe headaches almost daily that are punctuated by severe and debilitating migraine attacks.

Documentation is key when reporting the new codes. Providers will need to be educated to be certain that their documentation meets payers’ expectations for specificity. According to ICD-9-CM official guidelines, "not otherwise specified" codes are used only when the medical record is insufficient to allow the coder to choose a more specific code.

Nichole VanHorn
Clinical/Technical Editor


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