Complex Migraine with Unilateral Weakness

“In the kNOW” this month will be covering the 2nd Quarter 2025 Coding Clinic topic of a complex migraine with unilateral weakness. To start, let’s find out more about a complex migraine. This type of migraine can cause a patient to exhibit symptoms of a stroke. There are several different types of migraines that are categorized as complex. They include hemiplegic migraines, atypical migraines, or migraines with aura. An aura is a period of time prior to the migraine during which sensory or neurological disturbances occur. Auras can include issues with vision, cognition, motor skills, or sensory perception.

Hemiplegic migraines are a subtype of migraines with aura. This rare type of migraine will present with motor weakness. Generally, it is more common for the patient to experience visual symptoms as an aura, but as noted above, patients may also experience impairment in their mental status, sensation, or even speech difficulty.

Here is a scenario for review:

A patient presents to the ER with the following symptoms:

Left-sided face, arm, and leg weakness 

Photophobia of the left eye

Right tongue deviation

Twitching of the left side of the face

These symptoms prompted an immediate stroke evaluation. A CT scan of the head was obtained, and a stroke was able to be ruled out. The patient’s final diagnosis was left-sided facial droop and left-sided weakness due to a complex migraine.

What is the correct code assignment for the left-sided weakness for this scenario?

The advice from Coding Clinic refers us back to a previous Coding Clinic from the 1st Qtr. 2015. In that issue, advice was provided on how to code for unilateral weakness when it is associated with a brain disorder. Coding professionals were directed to code that to hemiplegia/hemiparesis. With a migraine being considered a type of brain disorder, we can now reference the index to determine the appropriate code assignment.

 

Alphabetic Index: 

 

 

 

Tabular Index 

This 2nd Qtr. 2025 advice reminds coding professionals that older advice may need to be referenced in order to answer a coding question.

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.