Billing question for headaches

[Superbiller]

I am at a new practice and the Dr. frequently uses 307.81(tension headache) to bill for e/m exam.

I don't recall EVER using this code at my previous office and in fact when I looked at my old superbill, headache was listed under 784.0? But honestly I don't think I ever used that one either. When I tried to look up billing guidelines for Optometry with those codes, it pulls up mostly chiropractic billing issues.

Any billers out there have any input on what you code for headache and if you are getting reimbursed.

Thanks!

[ddfamf]

Hi SB,

307.81 (Tension Headache) is a fine code. It should do the job nicely for reimbursement using the E/M codes (99 codes).

The HA diagnosis you referenced (784.0) is also a fine code, reimbursed by Medicare for E/M services.

However, I do know of a couple medical plans (BCBS-KC for one) that classify the 784.0 diagnosis as a VISION diagnosis and not a MEDICAL diagnosis.

Bottom-line ---- HA is a weird pseudo-diagnosis thing that morphs the line between vision and medical depending on the insurance-company being billed.

Best wishes!