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.
When was your last migraine check-up?