Health Information Management

Eyes on the migraine

HIM-HIPAA Insider, October 20, 2014

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Jeff, an 18-year-old male, came into the Fix ‘Em Up Clinic with complete left oculomotor palsy. Jeff stated he had a severe, throbbing headache around his eye yesterday. He took some aspirin and went to sleep.
When he woke up this morning, he had troubled seeing out of his left eye because his left eyelid was drooping so much. He says overall his vision is blurry and the area around his left eye is very painful.
Fortunately for Jeff, Dr. Achy is on the case. Dr. Achy documented that Jeff’s left pupil was 6 mm in diameter and reactive to light. She performed a neurological exam and ordered x-rays, both of which were normal.
To be on the safe side, Dr. Achy ordered an MRI and magnetic resonance angiography to rule out really bad things such as tumors and aneurysms. Again, the tests came back normal. Dr. Achy also ruled out glaucoma.
Dr. Achy prescribed two aspirin and Jeff’s symptoms almost completely resolved. It’s a miracle, but what on earth is wrong with Jeff?
He has an ophthalmoplegic migraine, a very rare headache that tends to occur in younger adults.
The pain centers around one eye and is usually less intense than in a standard migraine. It may be accompanied by vomiting, double vision, a droopy eyelid, and paralysis of eye muscles. Attacks can last from hours to months.
In ICD-9-CM, we would report code 346.20 (variants of migraine, not elsewhere classified, without mention of intractable migraine without mention of status migrainosus). That doesn’t really tell us much about Jeff’s specific condition. “Without mention” appears twice in the code description and it’s a not elsewhere classified code—we have information, but no specific code available.
ICD-10-CM resolves part of that problem. We will have a code for ophthalmoplegic migraine. In fact, we have two:
  • G43.B0, ophthalmoplegic migraine, not intractable
  • G43.B1, ophthalmoplegic migraine, intractable
We know the migraine is not intractable because it resolved with standard treatment. First, Dr. Achy didn’t document it as intractable. Second, “intractable” means the headache doesn’t resolve with the usual treatment. Jeff’s condition improved after he took some aspirin.
That gives us G43.B0.
If you see a lot of migraine patients in your facility or organization, check the physician documentation to make sure he or she is noting the type of migraine, e.g., with aura, without aura, with status migrainosus, persistent.
ICD-10-CM includes much more detailed choices for migraines so if your physicians aren’t documenting to the level of specificity you need in ICD-10-CM, start working with them now. Implementation is less than a year away.
This article originally appeared on HCPro’s ICD-10 Trainer blog.

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