ICD-10 Coding for Occipital Neuralgia(M54.81)
Complete ICD-10-CM coding and documentation guide for Occipital Neuralgia. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Occipital Neuralgia
M54.81Primary Range
Occipital neuralgia
This code is used for the diagnosis of occipital neuralgia, characterized by sharp pain in the occipital area.
Chronic migraine with aura
Used when occipital neuralgia coexists with chronic migraine with aura.
Key Information: ICD-10 code for occipital neuralgia
Essential facts and insights about Occipital Neuralgia
Primary ICD-10-CM Code for occipital neuralgia
Decision Criteria
clinical Criteria
- Presence of sharp, stabbing pain in the occipital region
documentation Criteria
- Documented response to occipital nerve block
Applicable To
- Sharp, stabbing pain in the occipital region
- Tenderness over the occipital nerve
Clinical Validation Requirements
- Paroxysmal stabbing pain in the occipital region
- Positive response to occipital nerve block
Code-Specific Risks
- Confusion with cervicalgia or other headache syndromes
Coding Notes
- Ensure documentation specifies occipital nerve involvement to differentiate from other headache types.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic migraine with aura
G44.841Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Occipital Neuralgia 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 of headache type., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure detailed documentation of pain characteristics., Verify nerve involvement.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data recording.
Mitigation Strategy
Use M54.81 when pain is specific to the occipital nerve.
Impact
Using M54.2 instead of M54.81 for occipital neuralgia.
Mitigation Strategy
Educate coders on the specific criteria for M54.81.
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 Neuralgia, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Occipital Neuralgia
Use these documentation templates to ensure complete and accurate documentation for Occipital Neuralgia. These templates include all required elements for proper coding and billing.
Occipital Neuralgia Diagnosis
Specialty: NeurologyRequired Elements
- Description of pain characteristics
- Response to diagnostic block
- Physical exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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