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.

Home Alone Holiday Hijinx

by Dianna Foley, RHIA, CHPS, CCS, CDIP

Test your ICD-10-CM injury and external cause knowledge by coding the scenarios below. 

The Klutz family is taking a well-deserved hiatus (probably to recuperate from all the torment they have been through). However, you can still practice your injury and external cause coding with this Home Alone themed story.

Watching Home Alone each year has become a Klutz family Christmas holiday tradition. This year, Mrs. Klutz is looking at the movie through new eyes as she has recently decided to return to school and is studying Health Information Management in order to become a medical coder. After her first semester coding ICD-10-CM, Mrs. Klutz was eager to practice what she had learned. This time, when the family gathered for the traditional viewing of Home Alone, she noted some of the injuries that occurred to the thieves, Marv and Harry. You can practice assigning codes for these and compare your answers with what Mrs. Klutz assigned. Mrs. Kultz just focused on the actual diagnosis and external event. She did not assign place of occurrence, activity, or status codes.

1. Harry burns the palm of his left hand when he touches a doorknob that Kevin heated. Blisters resulted.
2. Marv had broken glass, from crushed ornaments, embedded in his feet after climbing in through a window while barefoot.
3. Marv also manages to step on a nail, which pierces his right foot.
4. Harry’s scalp is burned by a blowtorch. The burns blister immediately.
5. Marv sustains contusions of his nose and forehead after being struck by a falling iron.
6. Marv gets a concussion with brief LOC from being struck in the back of the head by a shovel.
7. Harry is struck by a swinging paint can, falls down the stairs, and loses his gold tooth.

Mrs. Klutz was glad that her children were safe at home without injury this holiday…at least for now!  

Click HERE for the answers.

 

The ABC’s of CPT

“Spotlight on CPT” this month is going to focus on the ABC’s of CPT, that is the appendices in CPT. There are 20 appendices found in the back of the American Medical Association’s (AMA) CPT manual.
 

Here’s a quick run-down:
 

Appendix A – Modifiers
Appendix B – Summary of Additions, Deletions, and Revisions
Appendix C – Clinical Examples (deleted)
Appendix D – Summary of CPT Add-on Codes
Appendix E – Summary of CPT Codes Exempt from Modifier 51
Appendix F – Summary of CPT Codes Exempt from Modifier 63
Appendix G – Summary of CPT Codes That Include Moderate (Conscious) Sedation
Appendix H – Alphabetical Clinical Topics Listing (AKA-Alphabetical Listing)
Appendix I – Genetic Testing Code Modifiers
Appendix J – Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves
Appendix K – Product Pending FDA Approval
Appendix L – Vascular Families
Appendix M – Renumbered CPT Codes – Citations Crosswalk
Appendix N – Summary of Resequenced CPT Codes
Appendix O – Multianalyte Assays with Algorithmic Analyses and PLAs
Appendix P – CPT Codes That May Be Used for Synchronous Real-Time Interactive Audio-Video Telemedicine Services
Appendix Q – Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) (coronavirus disease [COVID-19]) Vaccines (deleted)
Appendix R – Digital Medicine-Service Taxonomy
Appendix S – Artificial Intelligence Taxonomy for Medical Services and Procedures
Appendix T – CPT Codes That May Be Used for Synchronous Real-Time Interactive Audio-Only Telemedicine Services
 

Some of these will be more familiar than others depending on the organization or provider type where a coding professional is employed. Many of us make frequent reference to Appendix A where the modifiers and their definitions are housed. (Quick note-in the AMA CPT manual, the modifiers are also found inside the front cover). In either location, it is important to remember that the modifiers do differ between those used by providers and those used for hospital outpatient services. For example, modifier 53 for discontinued procedure may be used by providers, but the hospital outpatient setting modifiers 73 or 74 would be used depending on if the patient received anesthesia or not.
 

Appendix B is a great resource to be used at the beginning of the year when the CPT codes are updated. This provides a comprehensive listing of all the changes that took place to codes for the upcoming year. If a code was revised, you can see exactly what was changed.
 

Appendix L addresses the first, second, and beyond second order determinations of vascular families. Interventional radiology coders will find this resource immensely helpful as not only is there a comprehensive listing of the vascular families but there are also many detailed illustrations.
 

Appendices P and T provide clarity on code that may be used to convey audio-video (P) or audio-only (T) CPT codes. In the CPT manual, the audio-video codes will be identified with a ★ symbol and indicate that modifier 95 must accompany the code. The audio-only codes are identified with and require modifier 93 be assigned.
 

As you can see, the appendices can provide a wealth of information. Don’t overlook them when assigning CPT codes. Many questions can be answered by just using these references.
 

Now, light has been shed on using the CPT appendices.

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.