Out of over four million diagnosis codes assigned in a one year period, headache accounted for 1.3% of the total ICD-9 code population placing the code 784.0 (headache) in the top ten diagnosis codes worked up in the emergency department and coded by McKesson. Migraine, another type of headache, (346.0 – migraine unspecified, without mention of intractable migraine or without mention of status migrainosus), ranked 33 or 0.6% of the total.

It is certainly interesting that the above two ICD-9 codes for headache or migraine headache were used or assigned most frequently when coding for the year in review. This means that physician documentation could have been more elaborate or potentially could have used other terms for the type of headache like allergic (ICD-9 - 339.00), due to lumbar puncture or spinal fluid loss (ICD-9 - 349.0), associated with sexual activity or orgasmic (ICD-9 – 339.82), or tension (307.81) to assign a more appropriate code for the encounter.

The frequency, duration, location, and severity of the headache; the factors that make it better or worse; associated signs and symptoms, such as fever, stiff neck, nausea and vomiting; and special studies help identify the cause of the headache. This will help determine as well the type of headache the patient is experiencing and the course of action for treatment.

There is a one to one crosswalk for Headache, but there are few other types of headaches that fall under the same ICD-9 (784.0) or ICD-10 code (R51) as outlined in the below table.

EM Head Ache Code 1

Useful tests could include CBC, STS, serum chemistry profile, ESR, CSF, examination, and, study for specific symptoms, ocular tests (acuity, visual fields, refraction, intraocular pressure) or sinus x-rays. If the cause of recent, persistent, recurrent, or increasing headache remains in doubt, MRI and/or CT may be appropriate.

Headache codes are located in several sections of ICD-9 depending on the type of headache diagnosed. Pain disorders related to psychological factors, section 307.8, includes the emotional, nonorganic origin, psychogenic, psychophysiologic and tension headache under the same code (307.81). To further illustrate the different types of headaches and their comparison codes from ICD-9 to ICD-10, see the table below.

EM Head Ache Code 2

 As you can see in the above table there are a number of ICD-10 codes for headache – and this is only a small example of those in both ICD-9 and ICD-10 books. It is imperative that the provider document exactly what the examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study.

This commentary is a summary prepared by McKesson’s Business Performance Services division and highlights certain changes, not all changes, in 2014 CPT® codes relating to the specialty of emergency medicine and emergency medical

services. This commentary does not supplant the American Medical Association’s current listing of CPT® codes, its documentation in the annual CPT Changes publications, and other related publications from American Medical Association, which are the authoritative source for information about CPT® codes. Please refer to your 2014 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this document.

CPT is a registered trademark of the American Medical Association (“AMA”). The AMA is the owner of all copyright, trademark and other rights to CPT® and its updates.

Author - Male

About the author

Robert Bunting, CPC, CPC-H, CHC, CEDC, CEMC, CAC is Compliance Director – Emergency Medicine, McKesson Business Performance Services.