Diagnosing Migraine - ICHD-3 versus ICD-10
Health care providers, like patients, often feel hamstrung by insurance companies that dictate who gets paid, how much they get paid, and for what diagnoses payment is made. US-based insurance companies only accept ICD-10 diagnostic codes, not the International Classification of Headache Disorders. This makes for a difficult situation because the ICHD-3 contains a few hundred different headache disorders while the ICD-10 lists only a handful. The end result is that most headache disorders are not represented.
As migraine patients become better educated, we’ve learned that the ICHD-3 is the gold standard for diagnosing headache disorders. We are encouraged to seek out doctors who specialize in headache medicine and use the ICHD-3 as their diagnostic reference.
Doctors, on the other hand, are probably instructed to use both the ICDH-3 and the ICD-10 in much the same way I was taught to use the DSM-5 and ICD-10. Essentially, the lesson looks something like this:
- The diagnostic manual is simply a tool for maintaining consistent language from one health care provider to the next.
- Not every ailment, disease, or condition that can afflict a person will necessarily be listed in the manual. The ones listed are simply those on which a majority of doctors agree.
- That’s what the Appendix is for. It outlines other possible diagnoses for future consideration. Many times conditions and diseases listed in the Appendix eventually get listed as official diagnoses once scientific research accumulates the necessary data to support them.
- The ICD-10 (everywhere else) are really only used to complete insurance paperwork. In the US health care system, insurance companies often dictate treatment protocols by refusing to pay for services they deem are unnecessary. No good health care provider should base his or her treatment recommendations purely based on the likelihood of insurance reimbursement.
Specialists understand this dichotomy and learn to work with both systems in order to achieve good patient care. However, general practitioners and physicians in other specialties may or may not be familiar enough with the ICHD-3 to use it as a diagnostic tool. In that case, they will most likely rely on a combination of their training and the limitations of insurance providers. On average, medical school students receive about 4 hours of training on headache disorders.
Most migraine patients have more education on headache disorders than general practice doctors receive in medical school. Some doctors do make a point to further study headache medicine either by obtaining board certification in headache medicine or by electively choosing headache and migraine related CEUs. Hopefully your doctor is using the ICHD-3 and staying current on the science of headache medicine.
Sometimes the interplay of ICD-10 ad ICHD-3 presents a problem when we request our medical records. Some doctors will use the ICHD-3 to diagnose migraine and other headache disorders. However, if you have insurance, somewhere in that paperwork is likely to be an ICD-10 diagnosis that may or may not resemble your true diagnosis at all. If that happens, it’s important to know why such a thing can occur. As with any health care issue, please talk to your doctor if you have concerns about how your headache disorder is officially diagnosed.
Editorial Note: The original version of this article listed the ICD-9 as currently being used in the U.S. We have corrected this error. ICH-10 has been used in the U.S. since October 2015 and is required for all HIPAA-compliant healthcare organizations. We apologize for the oversight and thank our readers for their kind diligence in bringing it to our attention.
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