How to Bill and Code for Migraine Headache

by | Published on Oct 3, 2023 | Specialty Billing, Specialty Coding

Bill and Code for Migraine Headache
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Migraine, a prevalent neurological disorder, manifests with diverse symptoms, primarily characterized by an intense, pulsating headache typically affecting one side of the head. The severity of the migraine tends to escalate with physical exertion, exposure to bright lights, loud noises, or certain odors. These debilitating episodes can persist for a minimum of four hours and sometimes extend over multiple days. Migraines belong to the primary headache category, signifying that they arise independently and are not triggered by an underlying medical condition. Primary headache disorders are typically diagnosed based on clinical assessment, meaning that there are no specific blood tests or imaging studies required for diagnosis. Conversely, secondary headaches serve as symptoms of other underlying health problems. The pain results from the stimulation of nerve fibers situated within the blood vessel walls as they traverse the meninges, which are the three layers of membranes that shield the brain and spinal cord.

Several distinct factors can trigger migraine. These differ from one individual to another and encompass:

  • Sudden changes in weather or environment
  • Too much or not enough sleep
  • Strong odors or fumes
  • Emotion
  • Stress
  • Overexertion
  • Loud or sudden noises
  • Motion sickness
  • Low blood sugar
  • Skipped meals

Different Types of Migraine

There exist various types of migraines, and a single type may be referred to by different names:

Migraine with aura (complicated migraine): Roughly 15% to 20% of individuals with migraine headaches experience an aura.

Migraine without aura (common migraine): This type of migraine headache occurs without the warning signs that an aura might provide. The symptoms remain the same, but the aura phase is absent.

Migraine without head pain: Also known as a “silent migraine” or “acephalgic migraine,” this variant includes the aura symptoms but lacks the typical headache.

Hemiplegic migraine: This type is characterized by temporary paralysis (hemiplegia) or neurological and sensory alterations on one side of the body. The onset of the headache may coincide with temporary numbness, profound weakness on one side of the body, tingling sensations, loss of sensation, dizziness, or changes in vision. Sometimes it includes head pain, while other times it does not.

Chronic migraine: Chronic migraine is characterized by experiencing migraines on at least 15 days each month. The symptoms can vary frequently, as can the intensity of the pain. Individuals with chronic migraines may find themselves relying on headache pain medications for relief on more than 10 to 15 days a month. Regrettably, this excessive medication use can further exacerbate the frequency of headaches.

Ocular migraine: Ocular migraine, also referred to as ophthalmic or retinal migraine, is a condition characterized by brief episodes of partial or complete vision loss in one eye. This vision disturbance is often accompanied by a mild, throbbing discomfort located behind the affected eye, which may radiate to other areas of the head.

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Symptoms associated with migraine headaches include the following:

  • Sensitivity to light, noise, and odors.
  • Nausea and vomiting, accompanied by an upset stomach and abdominal pain.
  • Loss of appetite.
  • Experiencing extreme warmth (sweating) or cold sensations (chills).
  • Paleness of the skin (pallor).
  • Profound fatigue.
  • Dizziness and blurred vision.
  • Tenderness of the scalp.
  • Occasional occurrence of diarrhea.
  • Infrequent occurrence of fever.

Migraine headaches are typically chronic in nature, meaning they are ongoing and cannot be completely cured. However, it is possible to manage and potentially improve the condition. There are two primary treatment approaches involving medications: abortive and preventive strategies.

  • Abortive medications are most effective when administered at the initial indications of a migraine. It is advisable to take them when the pain is still mild. These medications function by potentially halting the progression of the headache, thereby helping to cease or reduce migraine symptoms such as pain, nausea, light sensitivity, and more. Some abortive medications achieve this by narrowing the blood vessels, returning them to their normal state and alleviating the pulsating pain.
  • Preventive, also known as prophylactic, medications are typically recommended when migraine headaches are severe, happening more than four times a month, and significantly disrupting daily life. These medications are aimed at diminishing both the frequency and the intensity of the headaches. They are typically taken consistently on a daily basis to proactively prevent the occurrence of migraines.

ICD-10 Codes and CPT Codes Relevant for Migraine

Billing and coding for migraine headaches involves using the appropriate codes to accurately document and report the patient’s condition for insurance and billing purposes.

ICD-10 Codes for migraine headache: For migraine headaches, one may use codes from the G43 category. The specific code will depend on the type of migraine, such as:

  • G43.0 – Migraine without aura
  • G43.1 – Migraine with aura
  • G43.8 – Other migraine
  • G43.9 – Migraine, unspecified

CPT Codes: When billing for a patient visit or procedure related to migraine headaches, you should use the appropriate Current Procedural Terminology (CPT) code. This could include evaluation and management (E/M) codes for office visits, or specific procedure codes if any diagnostic or treatment procedures are performed. The specific code will depend on the services rendered.

Here are some CPT codes that may be relevant for migraine treatments:

    • Evaluation and Management (E/M) Services

99201-99205: Office or other outpatient visits for the evaluation and management of new patients with varying levels of complexity.
99211-99215: Office or other outpatient visits for established patients with varying levels of complexity.

    • Injection and Infusion Therapy

96372: Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular).
96374: Therapeutic, prophylactic, or diagnostic injection (intravenous push).
96375: Therapeutic, prophylactic, or diagnostic injection (intravenous infusion).

    • Nerve Blocks

64405: Injection, anesthetic agent; greater occipital nerve.

    • Neurostimulator Implantation

64568: Incision for implantation of neurostimulator electrode array; cranial nerve.

    • Imaging Studies

70450-70498: Radiological imaging codes (e.g., CT scans, MRI scans) for diagnostic purposes.

    • Electroencephalography (EEG)

95812-95827: EEG codes for the recording and interpretation of brainwave activity.

    • Neurology Consultations

99241-99245: Consultation codes for specialist evaluation and management of patients with complex medical issues, including migraines.

    • Physical Therapy and Rehabilitation

97110-97546: Codes for various physical therapy and rehabilitation services that may be used as part of a migraine treatment plan.

In some cases, one may need to use modifiers to provide additional information about the services rendered. For example, you might use a modifier to indicate that a procedure was bilateral or that it was a repeat procedure.

  • Modifier 25 – Significant, Separately Identifiable Evaluation and Management (E/M) Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used when an E/M service is provided on the same day as a procedure, such as a migraine injection or nerve block. It indicates that the E/M service was separate and distinct from the procedure.
  • Modifier 59 – Distinct Procedural Service: Modifier 59 is used to indicate that a procedure or service is separate and distinct from another service performed on the same day. It may be relevant when multiple procedures related to migraine treatment are performed during a single session.
  • Modifier 51 – Multiple Procedures: Modifier 51 is used to indicate that multiple procedures were performed during the same session. It may be applicable if multiple treatments or procedures are performed for migraine management during a single visit.
  • Modifier LT and RT – Left and Right: These modifiers are used when a procedure is performed on a specific side of the body (e.g., nerve blocks on the left and right sides of the head).
  • Modifier E1-E4 – Service by Assistant Surgeon: These modifiers indicate that the procedure was performed by an assistant surgeon, if applicable. While not directly related to migraine treatment, they can be relevant for complex procedures that involve surgical assistance.
  • Modifier QK – Medical Direction of Two, Three, or Four Concurrent Anesthesia Procedures Involving Qualified Individuals: This modifier may be relevant if anesthesia services are provided in conjunction with a migraine procedure.
  • Modifier GY – Item or Service Statutorily Excluded, Does Not Meet the Definition of Any Medicare Benefit: This modifier is used to indicate that a service or item is not covered by Medicare. It may be applicable when billing for services that Medicare does not cover.
  • Modifier GA – Waiver of Liability Statement Issued as Required by Payer Policy, Individual Case: This modifier is used to indicate that the patient has signed an Advance Beneficiary Notice (ABN) for a service that may not be covered by Medicare. It’s relevant when dealing with Medicare patients.

Many healthcare practices opt for medical billing and coding services or chiropractic billing services to streamline their financial processes and ensure accurate reimbursement for their services. It’s crucial to maintain accurate and thorough documentation to support the codes used for billing, as accurate coding is essential for proper reimbursement and compliance with healthcare regulations.

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Loralee Kapp

Since joining our RCM Division in October 2021, Loralee, who is HIT Certified (Health Information Technology/Health Information Management), brings her extensive expertise in medical coding and Health Information Management practices to OSI.

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