G43: ICD10 Code for Migraine

What is the ICD-10 Code for Migraine Without Aura?

The ICD-10 code for migraine without aura is G43.0. This is the most common type of migraine and is characterized by a severe, throbbing headache, often accompanied by nausea, vomiting, and sensitivity to light and sound. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) provides specific codes for different migraine presentations to ensure accurate diagnosis tracking and billing. Explore how ICD-10 codes are used for public health surveillance on the CDC website.

How Do I Code for Migraine With Aura in ICD-10?

Migraine with aura is coded as G43.1 in ICD-10. An aura is a sensory disturbance that precedes the headache, often involving visual phenomena such as flashing lights, blind spots, or zig-zag lines. Other aura symptoms can include tingling or numbness in the face or limbs. Accurate coding differentiates migraine with aura from migraine without aura and is essential for proper clinical documentation. Learn more about aura symptoms and migraine diagnosis from the American Migraine Foundation.

ICD-10 Code for Migraine with Status Migrainosus: What to Use?

Status migrainosus, a severe and prolonged migraine attack lasting over 72 hours, is coded as G43.11 in ICD-10. This condition requires prompt and aggressive treatment and is often managed in a hospital setting. The distinction between status migrainosus and other migraine types highlights the importance of precise coding for effective treatment and resource allocation. Consider implementing standardized protocols for managing status migrainosus based on guidelines from the American Headache Society.

How Do I Document Chronic Migraine in ICD-10 for Billing and Reimbursement?

Chronic migraine is coded as G43.41 in ICD-10. This diagnosis requires at least 15 headache days per month, with at least 8 of those days meeting criteria for migraine. Proper documentation of headache frequency, associated symptoms, and disability is crucial for accurate coding and successful reimbursement. Explore the resources provided by the Centers for Medicare & Medicaid Services for specific billing guidelines related to chronic migraine.

Can AI Scribes Like S10.AI Help with Accurate ICD-10 Coding for Migraines?

AI-powered scribes, such as S10.AI, can assist clinicians with accurate ICD-10 coding for migraines by automatically extracting relevant information from clinical documentation and suggesting appropriate codes. This can reduce administrative burden and improve coding accuracy, ultimately streamlining billing and reimbursement processes. Learn more about how S10.AI integrates with existing EHR systems to enhance clinical workflows.

ICD-10 Coding for Hemiplegic Migraine: What’s the Correct Code?

Hemiplegic migraine, a rare subtype characterized by temporary weakness or paralysis on one side of the body, is coded as G43.81 (for hemiplegic migraine without aura) or G43.82 (for hemiplegic migraine with aura). The precise coding for this complex condition underscores the importance of detailed clinical documentation capturing the specific neurological manifestations. Consider implementing specialized diagnostic criteria for hemiplegic migraine based on information from the National Institute of Neurological Disorders and Stroke.

What’s the Difference Between G43.2 and G43.3 in ICD-10 Migraine Coding?

G43.2 refers to complicated migraine, while G43.3 represents ophthalmoplegic migraine. Complicated migraine involves persistent neurological deficits, whereas ophthalmoplegic migraine is characterized by weakness or paralysis of the eye muscles. These distinct conditions require specific ICD-10 codes for accurate documentation and clinical management. Explore how differential diagnosis of these migraine subtypes impacts treatment strategies outlined by the World Health Organization.

Migraine with Brainstem Aura ICD-10: How to Code It?

Migraine with brainstem aura, also known as basilar migraine, is coded as G43.83 in ICD-10. This subtype involves neurological symptoms originating in the brainstem, such as dizziness, vertigo, and double vision. Accurate coding is essential for distinguishing this condition from other migraine variants. Learn more about the diagnostic criteria and management of basilar migraine from the Mayo Clinic.

How Can Universal EHR Integration Improve ICD-10 Coding Accuracy for Migraines?

Universal EHR integration can significantly improve ICD-10 coding accuracy for migraines by enabling seamless data exchange between different healthcare systems. This allows clinicians to access complete patient histories and ensure consistent coding practices. Explore how S10.AI facilitates universal EHR integration to enhance clinical documentation and coding accuracy across different platforms.

Coding for Abdominal Migraine in Children: What's the ICD-10 Code?

Abdominal migraine, a type of migraine affecting children, is coded as G43.84. Characterized by recurrent episodes of abdominal pain, nausea, and vomiting, accurate coding is crucial for distinguishing this condition from other gastrointestinal disorders. Consider implementing diagnostic criteria for abdominal migraine based on guidelines from professional pediatric organizations like the American Academy of Pediatrics.

Comparing G43.0 and G43.9 in ICD-10: Migraine Coding Nuances.

G43.0 signifies migraine without aura, while G43.9 represents unspecified migraine. The latter is used when the migraine presentation doesn't fit specific criteria for other subtypes. Understanding these nuances is crucial for accurate coding and reflects best practices in clinical documentation. Explore detailed ICD-10 coding guidelines from the National Center for Health Statistics.

FAQs:

1) What are the ICD-10-CM codes and subcodes for different types and subtypes of migraine, including those with and without aura, hemiplegic migraine, chronic migraine, and menstrual migraine?

ICD-10-CM coding offers a detailed structure to capture the full spectrum of migraine presentations, accommodating the nuances that impact both clinical care and reimbursement. Choosing the most specific code available enhances care coordination and billing accuracy. Here’s a concise guide to common migraine codes and their relevant subcategories:

Major Migraine Categories  Their Subcodes

Migraine Without Aura (G43.0)

Not intractable: G43.00

with status migrainosus: G43.001

without status migrainosus: G43.009

Intractable: G43.01

with status migrainosus: G43.011

without status migrainosus: G43.019

Migraine With Aura (G43.1)

Not intractable: G43.10

with status migrainosus: G43.101

without status migrainosus: G43.10

Intractable: G43.11

with status migrainosus: G43.111

without status migrainosus: G43.119

Hemiplegic Migraine (G43.4)

Not intractable: G43.40

with status migrainosus: G43.401

without status migrainosus: G43.409

Intractable: G43.41

with status migrainosus: G43.411

without status migrainosus: G43.419

Chronic Migraine (G43.7, G43.E)

Without aura:

Not intractable: G43.70 (status: G43.701/G43.709)

Intractable: G43.71 (status: G43.711/G43.719)

With aura:

Not intractable: G43.E0 (status: G43.E01/G43.E09)

Intractable: G43.E1 (status: G43.E11/G43.E19)

Menstrual Migraine (G43.82, G43.83)

Not intractable: G43.82 (status: G43.821/G43.829)

Intractable: G43.83 (status: G43.831/G43.839)

Other Noteworthy Migraine Types

Persistent Migraine Aura (G43.5, G43.6)

Without cerebral infarction: G43.50–G43.519

With cerebral infarction: G43.60–G43.619

Cyclical Vomiting in Migraine (G43.A)

Not intractable: G43.A0

Intractable: G43.A1

Ophthalmoplegic Migraine (G43.B)

Not intractable: G43.B0

Intractable: G43.B1

Abdominal Migraine (G43.D)

Not intractable: G43.D0

Intractable: G43.D1

Other Migraines (G43.8)

Not intractable: G43.80 (status: G43.801/G43.809)

Intractable: G43.81 (status: G43.811/G43.819)

Migraine, Unspecified (G43.9)

Not intractable: G43.90 (status: G43.901/G43.909)

Intractable: G43.91 (status: G43.911/G43.919)

Documentation Tips

Always code to the highest degree of specificity, accounting for intractability and the presence of status migrainosus.

Distinguishing features like aura, hemiplegia, and chronicity can impact both clinical decision-making and billing.

Use resources from organizations like the American Migraine Foundation and the American Headache Society for clarification on diagnostic criteria.

For a visual breakdown and coding algorithms, visit the CDC’s or CMS’s guidelines for ICD-10 migraine coding.

2) What are the additional codes to specify manifestations or complications related to migraine and medication use?

When coding for migraines, it's important to capture not only the primary migraine code but also any manifestations or complications stemming from medication use. ICD-10 offers a range of additional codes to help specify these scenarios and ensure comprehensive clinical documentation. Here’s how you can enhance coding precision for such cases:

Adverse Effects of Medications: If a patient experiences an adverse reaction to a medication prescribed for migraine management (such as triptans, antiemetics, or prophylactic agents), you should also code the specific adverse effect. Common examples include:

Gastritis due to medication: Use a code from the K29 category to denote drug-induced gastritis.

Dermatologic reactions: L23-L27 codes address contact or internal dermatitis linked to medication.

Hematologic complications: D56-D76 codes capture blood disorders as a potential adverse outcome.

Poisoning or Overdose: For situations involving unintentional overdose, incorrect medication, or accidental ingestion, assign poisoning codes from the T36-T50 series for the involved drug. Be sure to include the appropriate fifth or sixth character to indicate the specific scenario (such as adverse effect or poisoning).

Underdosing and Compliance Issues: If the issue relates to underdosing—whether because of noncompliance or misunderstanding the prescription instructions—additional codes such as Z91.12- (noncompliance with medication regimen) and Z91.13- (history of noncompliance) help clarify the context

Manifestations of Poisoning or Adverse Reactions: Use associated codes to specify clinical findings or complications resulting from the medication issue, such as acute nephropathy (N14.0-N14.2) or other organ-specific manifestations identified during the clinical evaluation.

In summary, optimal migraine coding includes:

The specific migraine diagnosis code.

Additional codes for any documented medication complications, adverse effects, or compliance issues, selected from the appropriate ICD-10 categories.

Codes for resultant clinical manifestations linked to the medication event.

This layered approach furnishes a more complete clinical picture, supporting both precise reimbursement and high-quality continuity of care.

3) What are the coding instructions for specifying adverse drug effects or manifestations in patients with migraine?

When a patient with migraine experiences adverse drug effects, poisoning, or underdosing—whether from migraine medications or other substances—it's important to capture this accurately for billing and clinical documentation.

Key Steps for Coding Adverse Drug Effects:

Start with the Migraine Code: First, assign the appropriate ICD-10 code for the patient's primary migraine diagnosis (e.g., G43.0 for migraine without aura).

Add the Drug Effect Code: If the migraine or its treatment results in an adverse drug effect or poisoning, use an additional code from ICD-10 categories T36–T50 to identify the specific drug involved. Be sure to use a fifth or sixth character “5” for adverse effects.

Document the Manifestation: Include codes for any resulting conditions or symptoms, such as:

Gastritis (K29.-) if the patient develops gastrointestinal symptoms,

Dermatitis (L23–L27) if allergic skin reactions occur,

Nephropathy (N14.0–N14.2) for drug-related kidney issues,

Blood disorders (D56–D76) if hematological complications arise.

Include Underdosing or Failure in Dosage: If underdosing is a concern—either deliberate or accidental—use Z91.12- or Z91.13- codes, and note any failures in medication administration (Y63.6, Y63.8–Y63.9).

Practical Tip: Always code first for the primary diagnosis (migraine subtype), then layer on codes for drug-related events and their clinical consequences. This ensures your claims reflect both the underlying condition and any complicating factors—minimizing denials and supporting high-quality care.

For more examples and documentation best practices, refer to the American Academy of Neurology’s coding resources, or consult the CDC’s ICD-10-CM guidelines for drug-related adverse events.

4) When should the "use additional code" and "code first" notes be applied in migraine-related coding?

When coding for migraines, you may occasionally encounter use additional code and code first notes in the ICD-10 manual. These notes indicate the correct sequencing when migraines are associated with another underlying condition or a specific manifestation.

Here’s how to apply them:

Code First Note: If the migraine is a complication or manifestation of another condition (such as a metabolic disorder or infectious disease), start by coding the underlying cause. The code first note tells you the primary condition must be entered before the migraine.

Use Additional Code Note: After listing the primary (etiology) code, you then add the migraine code as an additional diagnosis. This captures both the underlying condition and its migraine-related effect.

You’ll often see manifestation codes labeled as “in diseases classified elsewhere.” These codes are never used as the primary diagnosis—instead, they work alongside the related etiology codes to provide a full clinical picture.

For example, if a patient’s migraine is related to a systemic disorder, you would:

Sequence the systemic disorder code first (per code first instruction).

Follow with the migraine code (using the use additional code guidance).

Following these conventions ensures proper documentation, supports accurate billing, and reflects clinical complexity. Check the latest guidelines from the American Academy of Neurology and the official ICD-10-CM references for more on etiology/manifestation coding practices.

5) What other headache syndromes are detailed in ICD-10-CM and how are they differentiated from migraines?

ICD-10-CM Headache Syndromes Beyond Migraine

While migraines remain at the forefront of ICD-10 headache classifications, a wide range of other headache syndromes are also captured in the G44 category—each with distinct clinical features and coding considerations. Understanding these distinctions can further refine diagnosis and management strategies for complex headache presentations.

Cluster Headaches and Trigeminal Autonomic Cephalalgias (TACs)

Cluster headaches and other TACs are defined by intermittent, severe, unilateral pain often accompanied by autonomic symptoms (like tearing or nasal congestion). ICD-10 provides specific codes for episodic and chronic forms, as well as for related syndromes such as paroxysmal hemicrania and short-lasting unilateral neuralgiform headache attacks (SUNCT/SUNA). Notably, codes also distinguish between intractable and not intractable presentations.

Tension-Type and Vascular Headaches

Tension-type headaches, the most common primary headache disorder worldwide according to the World Health Organization, are categorized as unspecified, episodic, or chronic, with differentiation for intractability. Vascular headache, not elsewhere classified, encompasses headache types with a suspected vascular origin that do not fit migraine criteria.

Post-Traumatic and Drug-Induced Headaches

For headaches caused by trauma or drug exposure, ICD-10 offers nuanced codes to indicate whether the condition is acute, chronic, or unspecified, and whether it is intractable. This level of detail supports personalized treatment planning and documentation aligned with recommendations from organizations like the International Headache Society.

Complicated and Rare Headache Syndromes

Some headache types, such as hemicrania continua, new daily persistent headache (NDPH), primary thunderclap headache, and other rare forms, are grouped under complicated or other specified headache syndromes. These conditions often require exclusion of secondary causes and may present diagnostic challenges.

Other Notable Primary Headaches

Additional codes exist for primary cough headache, exertional headache, stabbing headache, hypnic headache, and headaches associated with specific activities (such as sexual activity or exertion). Cervicogenic headaches—originating in the cervical spine—are also separately identified.

By leveraging specific ICD-10 codes for these diverse headache syndromes, clinicians can ensure precise documentation, more targeted therapy, and improved alignment with national and global diagnostic guidelines.

6) How is facial pain or lower half migraine classified and coded?

Facial pain that does not have a specific underlying cause is typically classified as headache, unspecified and is coded as R51.9 in ICD-10. This broad code encompasses a range of head and facial pain presentations where a more definitive diagnosis is not established. For documentation purposes, be sure to clearly describe any atypical features or associated symptoms to rule out secondary causes.

Lower half migraine, which may present as pain predominantly affecting the lower regions of the head or face, is most often categorized under cluster headache syndrome, unspecified with the code G44.00. This code also covers related conditions such as ciliary neuralgia, cluster headache NOS, histamine cephalgia, and migrainous neuralgia. When coding these conditions, distinguishing clinical features and relevant history should be documented thoroughly to support accurate diagnosis and ensure appropriate ongoing management.

7) How are adverse effects, poisonings, and underdosing of drugs coded in relation to migraines?

When migraine treatments lead to adverse drug effects, poisoning, or issues with underdosing, accurate ICD-10 coding becomes especially important. These scenarios require additional attention to detail beyond the primary migraine diagnosis.

Key Steps for Coding Drug-Related Events:

Start by coding the nature of the adverse effect, poisoning, or underdosing—such as gastrointestinal symptoms, dermatological reactions, or nephropathy—using the most appropriate ICD-10 codes.

Next, identify the specific drug involved using codes from the T36-T50 range. Always ensure that the correct fifth or sixth character is used (typically 5 to indicate an adverse effect).

If a patient experiences underdosing (either inadvertently or deliberately taking less medication than prescribed), document this with relevant ICD-10 codes reflecting the underdosing event and, if necessary, contributing factors like noncompliance.

Examples of What to Include:

Manifestations such as aspirin-induced gastritis (K29.-), drug-induced dermatitis (L27.-), or other specific symptoms related to the medication taken.

Codes for complications during medical care linked to underdosing (for example, Y63.- or Z91.1- series).

This layered approach ensures the medical record accurately reflects both the migraine event and any drug-related complications, supporting clearer communication and appropriate follow-up care.