In this topic we will briefly discuss about the types and causes of headache and in detail about the Headache ICD 10 coding guidelines.

Headache:

Every one of us regardless of age and gender suffer from headache often. Pain can occur at one side or both sides or entire head. The severity differs from mild, sharp, dull, moderate to severe. Reasons may be anything like stress, weather, depression, menstruation, high blood pressure, injury or any other illness. Sometimes we do not even know the reason, it just goes away after a tight sleep.

In this topic we will briefly discuss about the types and causes of headache and in detail about the coding guidelines.

Types of headache:

Depending on the cause of headache it is divided as primary and secondary.

• Primary Headache

This is due to any activity (physical or mental) which triggers the pain structures in head, not related to any underlying disease.

Few examples below which are commonly found in medical record.

• Cluster headache – It is so called because it occurs in patterns or clusters. It is very severe, pain comes at one side of the head mostly around one eye.
• Migraine – Severe headache at one side of the head with light sensitivity and nausea.
• Tension headache –Dull, mild to moderate pain around forehead or back of neck and head.

Apart from the above there are drug induced headache, exercise headache, cough headache, post-traumatic headache, sex related headache etc.

• Secondary Headache

In this case there is an underlying cause for the headache and it is one of the routine symptoms for such diseases.

Few examples below:

• Neoplasm/Cancer
• COVID 19
• Brain aneurysm
• Meningitis
• Encephalitis
• Glaucoma
• Intracranial hematoma
• Sinusitis
• Viral fever

Diagnosis and treatment:

Physician can diagnose the type of headache or the underlying cause depending on the area and severity of the pain and also from the history and physical exam. Based on these findings physician may do blood test, CT or MRI head, sinus X-ray, EEG or Spinal tap for further investigation. Coder needs to ­­­evaluate interpretation of these test results for more specific ICD code.

Headache ICD 10 codes and guideline:

Most of the commonly used codes for headache comes under categories G43 and G44 which can be found in chapter 6 (diseases of nervous system-code range G00-G99) in ICD-10 CM manual.

• Below are the new codes for headache to be used from October 1^st 2020

R51.0 –Headache with orthostatic component, NEC

R51.9 – Unspecified headache

For both the above codes, migraine (category G43) is in excludes 2. So, as per the guideline we can code excludes 2 code also if documented in the medical record. But if we see G43 category codes, there is R51.9 in excludes 1. Hence migraine (G43) and R51.9 should not be coded together. You need to code only migraine as it is more specified.

• As per ICD coding guidelines routine signs and symptoms of a definitive diagnosis should not be coded separately. Hence if headache is mentioned in the medical record and if it is a common symptom of the diagnosis which we are coding (secondary headache),remember to avoid coding unspecified headache R51.9
• Menstrual/Pre-menstrual headache should be coded as “migraine, menstrual”.

Codes and descriptions are given in the below table:

ICD-10 Code	Description
G43.001 – G43.019	Migraine: without aura
G43.101 – G43.119	: with aura
G43.401 – G43.419	: hemiplegic
G43.501 – G43.519	: persistent with aura without cerebral infarction
G43.601 – G43.619	: persistent with aura with cerebral infarction
G43.701 – G43.719	: chronic without aura
G43.801 – G43.839	: other type
G43.901 – G43.919	: unspecified type
G43.A0 – G43.A1	Vomiting, cyclical
G43.B0 – G43.B1	Migraine : ophthalmologic
G43.C0 – G43.C1	Periodic headache in adult or child
G43.D0 – G43.D1	Migraine : abdominal
G44.001 –G44.099	Cluster headache and TAC
G44.1	Headache : vascular
G44.201 – G44.229	: tension type
G44.301 – G44.329	: post-traumatic
G44.40 – G44.41	: drug induced
G44.51 – G44.59	Complicated headache syndromes
G44.81 – G44.89	Other specified headache
R51.0	Headache with orthostatic component
R51.9	Unspecified headache
G97.1	Headache caused by lumbar puncture
T88.59X-	Headache due to spinal and epidural anesthesia :
O74.5	: during labor and delivery
O29.4	: in pregnancy
O89.4	: postpartum

 

We will review few examples of headache:

Headache ICD 10 Example 1:

Christina, 65 year old female visits ER along with her daughter for a severe throbbing headache from past few days. Daughter states that her mom fainted today morning. She has associated symptom of photophobia and vomiting. She says the headache is severe at the front side of the head. Pain medications did not help to relieve her pain. She has a past medical history of COPD and hypertension for which she is taking Albuterol and Losartan. She has a fever of 102 F and BP 140/95 mm Hg today. Physical exam showed neck stiffness, knee pain while stretching, sensitivity to light and alteration of awareness. CT head and lumbar puncture is performed. Physician diagnosed bacterial meningitis as per CSF study.

ICD 10 codes for this scenario would be:

• G00.9 – Bacterial meningitis
• J44.9- COPD
• I10 – Hypertension

Note :  Here we do not need to code unspecified headache R51.9 as this is a symptom of meningitis.

Headache ICD 10 Example 2:

35 year old Martin has come to clinic with intermittent throbbing severe headache from past one month. He states pain occurs at left side of the head. He also has upper back pain. He works as a software developer. Due to the deadline of the projects he has more work and stress. He remembers that he start seeing bright spots on the monitor just before the headache. He feels even nausea when gets headache. His heart rate is 84 BPM, BP 123/85 mm Hg, respiratory rate 12 BPM. Physical exam mentioned alert and oriented, no significant weight loss, tachycardia, no neurological defects.

CT head was performed and diagnosed “migraine with aura”.

ICD codes for this scenario would be:

• G43.109 – Migraine with aura

Note: Unspecified headache R51.9 is not necessary to code here as per the excludes 1 note with G43.109

Headache ICD 10 Example 3:

Sally is 28 year woman who is mother of 2 kids, comes with a problem of headache started just 1 day before her periods.  From past 6 months it is happening for every period and lasts for 3 days. She states earlier she used to get abdominal pain during periods, though not every month. Today is her 2^nd day of period. She states the pain is very sharp at one side, feels some vision problem when watching TV, sometimes feel nauseated as well. She has past history of gestational hypertension and family history of breast cancer (mother).She does not have fever today. Vitals are normal. Physical exam showed photophobia, normal neurological exam and breaths normal. CT of the head was done and diagnosed “menstrual headache”

ICD-10 code for this case would be:

• G43.829.

Note: menstrual headache should be coded as migraine, menstrual.