Neurology Medical Coding Updates: Know the Key Terms for Headache Diagnoses


We've got a brand-new headache category, that's 339. We've added 24 new codes. The primary point here is that in essence, the new code parallels the International Headache Classification system, the ICHD-2. And if your neurologist sees any sizable quantity of headache patients, they're going to be very familiar with ICHD-2 medical coding and billing classification. So there will be an easier transition over for them.

These new headaches allow almost a one to one crossover when we get ready to adapt over to ICD-10. Well, looking at just some of the classifications since we have so much more specificity in headaches, let's look at the difference between a primary headache and a secondary headache.

A primary headache specifically is not associated with any underlying pathology. We don't have any injury or pathology or postoperative condition that is causing that headache. Migraine, tension-type or clusters are two types of primary headaches.

In contrast, a secondary headache is due to some underlying pathologic condition whether it's head or neck trauma, a cranial or cervical vascular disorder. We've got a brain tumor, drug induced or infection. One example of a secondary headache is a headache following a fall that we've bumped our head. And so, we have a headache itself that's due to some type of trauma.

Timing: These are critical when we're looking at our headache and migraine conditions. Primarily our headache, there's specific diagnosis and definition. Chronic is whenever we have attacks of headache occur on more days than not over a three-month period.

So if a patient relates that they have headaches more than 15 days per month for over a three-month period, we can now call that a chronic headache or providers would deem medical chronic headache.

Episodic just means that it comes and goes. There's a pattern of attacks that may not be a regular pattern of attacks but it remits and comes back, remits, comes back. So, it's episodic. Paroxysmal means that there's a sudden attack. It's an intensification of a disease. And persistent means that it remains in that same state for an indefinitely long time.

We're going to go over to some of these subclassifications. Our first section is our trigeminal autonomic cephalalgia. Our expert mentioned it in a medical coding conference that these are usually symptoms caused by that activation of the V1 or that division of the trigeminal nerve that's also known as our fifth cranial nerve.

And one of those is our cluster headaches. Cluster headaches, 339.0X is our most severe primary headache. There’s an attack of severe - it's strictly unilateral pain which is of course because of that trigeminal orientation. They're typically orbital, supraorbital or temporal in site. They last anywhere from 15 to 180 minutes.

But the key thing is that those headaches (occur) in a series which lasts from several weeks to several months separated by remission. So the headaches occur in clusters. And that's where the name comes from. They occur in clusters and then they go away. They occur in clusters. Most often those clusters occur for six to 12 weeks at a time with a remission period typically lasting about 12 months.

The next one is tension type headache. We need to clearly define the difference between a tension headache that's triggered by psychological factors. We still have that diagnosis code in the Mental Disorders chapter, 307.81. In contrast, the tension type headaches are due to physiological factors and they're going to be reported with these new codes. It is the most common type of primary headache.

It's typically bilateral, often described as viselike or a band-like sensation. It can have duration of minutes a day. It's very important that we work with our providers to clearly document the difference between a tension headache. versus a tension type headache so that we can accurately report the correct diagnosis code.

Post-traumatic headaches: It's a classic secondary headache. It occurs an injury to the head or the brain. So, we can have whiplash. We can have closed head trauma. We can have an intracranial hematoma. Or post-surgical, patient could have an open craniotomy for surgery. There are no typical characteristics. There is acute versus chronic that you'll want to look at.