Migraines are originally derived from that Greek word “hemicrania” which means half of the head. So, migraines as a whole are primary chronic recurrent headaches that often are familial. It's typically unilateral. It's felt at the temple as well as the front and the back. It can be moderate to severe intensity. It's worsened typically by ordinary daily activities. And a key consideration, it must be accompanied by either nausea or else photophobia which is light sensitivity or phonophobia which is sound sensitivity. Go through this expert neurology medical coding and billing article for more information on migraine diagnosis coding.
Again, these correlate with those international headache classification systems. An aura just to define that, that's when a patient has a warning symptom. Now, it can precede certain disorders such as a migraine but also we know that patients with epilepsy can also have an aura before. Primarily, it is a visual but also can be other symptoms of a warning system.
346.0X: That's formerly our classic migraine or that's our migraine with aura. These patients have migraine headaches that are typically preceded by those reversible aura symptoms. We have two new codes and two revised codes there.
Our 346.1 is migraine without aura. It's referred to formerly as common migraine. It's pain is virtually indistinguishable from those experienced by patients with aura. The big difference is these patients have no auras that their migraine attack.
As per the medical coding updates, we have two revised and two new. In the variants we've got two revised and two new. A hemiplegic migraine is a migraine that is with an aura but it's characterized by paralysis or motor weakness on one side of the body. That paralysis is usually temporary but it can sometimes last for days.
Now, this can either be familial or it can be sporadic. Our diagnosis codes 346.3X, they're both going to be reported whether there's not separate diagnosis for familial hemiplegic migraine or sporadic hemiplegic migraine. Both of those conditions are going to be reported under the 346.3 according to the medical coding updates.
Menstrual migraines are attacks in menstruating women. This code subclassification, 346.4X, includes both a purse menstrual migraine in women that have their migraines only during one day before and two days after their menstruation in at least two out of three menstrual cycles. And they have it no other time.
Menstrually related migraine: That's when they have their migraines associated with their menstruation but they also have it in addition to other times of the cycle. So again, 346.4X includes both pure menstrual migraine and menstrually related migraine.
Persistent migraine That's where we have aura symptoms persisting for greater than a week. Now, these symptoms may be bilateral. So, it's the aura that's a continuation. Now, migraines particularly with an aura is a risk factor for an ischemic stroke. That means that we have a decrease in blood supply to our brain. We can have brain damage. So a migraine infarction is one or more migrainous aura symptoms lasting greater than an hour. And it's associated with an ischemic brain lesion.
And so, we have 346.5 that's without cerebral infarction, 346.6 is with cerebral infarction as per the medical coding updates. So in one we have a persistent aura that has no brain damage. The other is a persistent migraine aura with brain damage. These patients in a neurology practice are typically seen in the ER and then moved on to the ICUs and inpatient setting.
Chronic migraines without aura: These are actually - they history of migraine attacks that gradually worsen over the period of months or years. And they eventually meet that definition of a chronic headache which is occurs more than 15 times per month from more than three months. The aka for this is also called a transformed migraine without aura.
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