ICD-10 Coding for Occipital Headache(M54.81, G44.847)
Complete ICD-10-CM coding and documentation guide for Occipital Headache. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Occipital Headache
M54.81Primary Range
Occipital neuralgia
Primary code for occipital neuralgia characterized by paroxysmal stabbing pain and tenderness over occipital nerves.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M54.81 | Occipital neuralgia | Use when pain originates from irritation of greater/lesser occipital nerves. |
|
| G44.847 | Cervicogenic headache | Use when headache is secondary to cervical spine disorder. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for occipital headache
Essential facts and insights about Occipital Headache
Primary ICD-10-CM Codes for occipital headache
Decision Criteria
clinical Criteria
- Presence of paroxysmal stabbing pain and tenderness over occipital nerves.
Applicable To
- Paroxysmal stabbing pain in occipital region
Excludes
- Cervicogenic headache (G44.847)
Clinical Validation Requirements
- Paroxysmal stabbing pain
- Tenderness over occipital nerves
- Positive response to nerve block
Code-Specific Risks
- Incorrectly using for cervicogenic headache.
Coding Notes
- Ensure documentation specifies nerve involvement and response to block.
G44.847 - Cervicogenic headache
Use when headache is secondary to cervical spine disorder.
Applicable To
- Headache originating from cervical spine
Excludes
- Occipital neuralgia (M54.81)
Clinical Validation Requirements
- Cervical spine disorder on imaging
- Pain exacerbated by neck movement
Coding Notes
Link headache to cervical pathology in documentation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Occipital Headache to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M54.81.
Impact
Clinical: Misdiagnosis risk., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use specific anatomical terms., Include diagnostic test results.
Impact
Reimbursement: Incorrect DRG assignment leading to denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use G44.847 when headache is due to cervical pathology.
Impact
Using M54.81 for headaches without neuralgia features.
Mitigation Strategy
Ensure documentation supports neuralgia diagnosis.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Occipital Headache, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Occipital Headache
Use these documentation templates to ensure complete and accurate documentation for Occipital Headache. These templates include all required elements for proper coding and billing.
Occipital Neuralgia Diagnosis
Specialty: NeurologyRequired Elements
- Subjective pain description
- Objective findings
- Response to nerve block
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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