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G43.009
ICD-10-CM
Migraine Without Aura

Find information on Migraine Without Aura, including diagnostic criteria, ICD-10 code G43.0, clinical documentation tips, and headache management resources for healthcare professionals. Learn about common migraine symptoms, differential diagnosis considerations, and best practices for accurate medical coding and billing. This resource provides valuable insights for physicians, nurses, and other clinicians involved in the diagnosis and treatment of migraine headaches without aura.

Also known as

Common Migraine
Migraine Headache

Diagnosis Snapshot

Key Facts
  • Definition : Recurrent headache disorder characterized by moderate to severe throbbing head pain.
  • Clinical Signs : Pulsating pain, nausea, vomiting, light and sound sensitivity, often unilateral.
  • Common Settings : Outpatient neurology clinics, primary care offices, telehealth consultations.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC G43.009 Coding
G43.0

Migraine without aura

Recurrent headache disorder characterized by unilateral throbbing pain.

G43.1

Migraine with aura

Migraine headache preceded by visual or sensory disturbances.

G43.8

Other migraine

Migraine variants not classified elsewhere, like hemiplegic migraine.

G43.9

Migraine unspecified

Migraine diagnosed, but type not specified or documented.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the headache consistent with migraine diagnostic criteria?

  • Yes

    Is aura present?

  • No

    Do NOT code as migraine. Consider alternative diagnoses.

Code Comparison

Related Codes Comparison

When to use each related code

Description
Migraine without aura
Migraine with aura
Chronic migraine

Documentation Best Practices

Documentation Checklist
  • Migraine without aura diagnosis ICD-10 G43.0
  • Document 5+ attacks fulfilling criteria
  • Headache lasting 4-72 hours (untreated)
  • At least two of: unilateral, pulsating, moderate-severe pain, aggravation by routine activity
  • At least one of: nausea/vomiting, photophobia/phonophobia

Coding and Audit Risks

Common Risks
  • Unspecified Laterality

    Coding migraine without aura without specifying laterality (if applicable) can lead to rejected claims or lower reimbursement. Use G43.009 for unspecified side, G43.011 for left, G43.012 for right, or G43.013 for bilateral.

  • Symptom Code Misuse

    Incorrectly coding migraine symptoms (nausea, photophobia) separately instead of using the comprehensive G43.009 for migraine without aura can cause claim denials due to unbundling.

  • Status Migrainosus Omission

    Failing to accurately document and code status migrainosus (G43.119) when a migraine lasts over 72 hours can lead to underpayment and inaccurate severity reflection.

Mitigation Tips

Best Practices
  • ICD-10 G43.00, track migraine triggers (diet, stress)
  • Document migraine frequency, intensity, duration for accurate coding
  • SNOMED CT 37796009, evaluate and manage comorbidities (anxiety, depression)
  • Medication adherence, lifestyle changes (sleep, exercise) improve outcomes
  • Regular neurological exams, patient education crucial for compliance

Clinical Decision Support

Checklist
  • 1. Headache 4-72 hours (ICD-10 G43.0)
  • 2. Nausea, vomiting, OR photo/phonophobia
  • 3. Not better explained by another diagnosis
  • 4. No aura symptoms present (SNOMED CT 37796009)

Reimbursement and Quality Metrics

Impact Summary
  • Migraine Without Aura reimbursement hinges on accurate ICD-10-CM coding (G43.00) for optimal payment.
  • Quality metrics for Migraine Without Aura track patient pain levels, ED visits, and medication efficacy.
  • Coding errors impact hospital reporting data for Migraine, affecting resource allocation and quality improvement initiatives.
  • Accurate documentation of headache characteristics, frequency, and associated symptoms is crucial for appropriate billing and diagnosis coding.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code G43.0 for Migraine without aura
  • Document headache characteristics
  • Rule out secondary headaches
  • Confirm diagnosis with physician
  • Review and update code if needed

Documentation Templates

Patient presents with a chief complaint of recurrent headache consistent with migraine without aura.  The patient reports experiencing moderate to severe, pulsating pain, typically unilateral and localized to the frontotemporal region.  Pain is aggravated by routine physical activity and accompanied by nausea, photophobia, and phonophobia.  Headache duration varies from 4 to 72 hours.  The patient denies any visual disturbances, sensory changes, or other neurological symptoms preceding the headache, ruling out migraine with aura.  Frequency of attacks is reported as approximately two per month.  Symptoms meet the International Classification of Headache Disorders (ICHD-3) diagnostic criteria for migraine without aura.  Differential diagnoses considered include tension-type headache, cluster headache, and secondary headache disorders.  Based on the patient's history and clinical presentation, migraine without aura is the most likely diagnosis.  Treatment plan includes acute management with NSAIDs such as ibuprofen or naproxen sodium, and triptans like sumatriptan or rizatriptan as needed.  Preventive therapy will be considered if acute treatments are insufficient or headaches occur frequently.  Patient education provided on migraine triggers, lifestyle modifications, and medication management.  Follow-up scheduled in four weeks to assess treatment efficacy and adjust plan as needed.  ICD-10 code G43.0 assigned.
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