![]() ![]() For example, G43 is “migraine,” whereas G43.1XX is “migraine with aura.” To develop corresponding ICD-10-CM diagnoses for the headache conditions above, we cross-walked the original ICD-9-CM codes for each condition coded in in FY 2014–2017 to ICD-10-CM codes using general equivalency mapping (GEMs). The category is followed by a decimal point and the subcategory. The first three characters of ICD-10-CM are the “category.” The category describes the general type of the injury or disease. Each code begins with a letter, and that letter is followed by two numbers. An ICD-10-CM is a seven-character, alphanumeric code. The ICD-10-CM is a system used by healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with health care in the US. Mapping headache diagnoses from ICD-9-CM onto ICD-10-CM We also explored whether provider type (primary care versus specialty care) and/or patient characteristics (age, sex, race/ethnicity) influenced ICD-10-CM coding. After mapping ICD-9-CM headache diagnoses onto the ICD-10-CM system, we sought to understand the continuity and specificity of coding specific headache subtypes. Little if any work has examined diagnostic trajectories of specific headache conditions with the transition from ICD-9-CM to ICD-10-CM. Previous work mapping any headache diagnosis with the transition from ICD-9-CM to ICD-10-CM noted a 0.75 odds ratio of being coded with a headache disorder in ICD-10-CM if an ICD-9-CM code existed for any type of headache. It should also be noted that, while there is no diagnostic category in ICHD for “headache,” ICD does contain a “headache” symptom code.Ĭlinicians were using the ICHD-3 beta criteria to diagnose headache diseases during the time when the VHA transitioned from ICD-9-CM to ICD-10-CM, clinicians were using the ICHD-3 beta criteria, which was introduced in 2013 and supplanted by ICHD-3 in 2018. For example, when considering patients with migraine with typical aura, the ICHD-3 beta diagnostic criteria had a false positive rate of 16.9%, whereas its predecessor, the ICHD-3, had a false positive rate of 10.5%, as compared to the diagnosis made by treating physicians. Headache classification and criteria have evolved over time, incorporating medicine’s growing understanding of headache conditions and the utility of previously used criteria in guiding clinicians in making distinct headache diagnoses. The first edition of the ICHD criteria was published in 1988 whereas its fourth edition is currently being developed. Primary headaches are those for which there is no known underlying etiology, whereas secondary headaches are attributable to an underlying condition or conditions thought to cause or have close temporal relationship to when a headache condition began. ![]() This classification schema initially divides headache diseases into primary (e.g., migraine) and secondary (e.g., post-traumatic headache headache. While coding of healthcare conditions such is guided by the ICD, diagnosis of headache conditions is guided by the International Classification of Headache Disorders (ICHD). ![]() Accuracy of headache diagnosis is important since different headache types respond to different treatments, and newer, more expensive migraine-specific treatments, are emerging rapidly and may not be available to patients unless they are accurately diagnosed and coded as having migraine. While resources exist to map ICD-9-CM conditions onto ICD-10-CM, the effect of this transition on coding of specific headache diagnoses is unknown. The new ICD-10-CM codes were expected to increase diagnostic specificity, hence aiding healthcare providers, payers, and policymakers in understanding disease prevalence, establishing appropriate reimbursement rates, and improving care quality and delivery. From this point onward, each ICD-9-CM diagnosis required manual recoding as an ICD-10-CM diagnosis in the EHR by healthcare provides managing headache. The VHA transitioned from the International Classification of Diseases and Related Health Problems, 9 th revision, Clinical Modification (ICD-9-CM) to the 10 th revision on October 1, 2015. The Veterans Health Administration (VHA) is the largest integrated healthcare system within the United States (U.S.) and provides electronic health record (EHR) data over time for veteran enrollees. Understanding the public health impact of headache and the treatment needs of people with headache requires accurate data, especially when reporting disease prevalence. Half of people with a headache history actively experience headache attacks. Headache has a lifetime prevalence of 66%. Headache is one of the most commonly diagnosed chronic conditions managed within primary and specialty care clinics. ![]()
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