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ICD-10 Guide
ICD-10 CodesG43.00

G43.00

Billable

Migraine without aura, not intractable

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G43.00 is a billable code used to indicate a diagnosis of migraine without aura, not intractable.

Key Diagnostic Point:

Migraine without aura, classified under G43.00, is characterized by recurrent headaches that are typically unilateral, pulsating in quality, and moderate to severe in intensity. These headaches are often aggravated by routine physical activity and are associated with nausea, vomiting, or photophobia and phonophobia. Unlike migraines with aura, patients do not experience transient neurological symptoms preceding the headache. The condition is considered 'not intractable' when the episodes are manageable and do not require frequent emergency interventions or hospitalization. Triggers for migraines can vary widely among individuals and may include stress, hormonal changes, certain foods, and environmental factors. Preventive treatments may include lifestyle modifications, pharmacological interventions such as beta-blockers, anticonvulsants, and antidepressants, as well as newer therapies like CGRP inhibitors. Accurate diagnosis and coding are essential for effective treatment and management of this prevalent headache disorder.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in patient symptoms and triggers
  • Differentiation from other headache types
  • Need for comprehensive patient history
  • Potential for co-morbid conditions

Audit Risk Factors

  • Inadequate documentation of headache frequency and severity
  • Failure to document treatment plans and responses
  • Misclassification of migraine type
  • Lack of patient history regarding triggers

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed headache diaries, patient history, and response to treatments.

Common Clinical Scenarios

Patients presenting with recurrent headaches, requiring differential diagnosis from other headache disorders.

Billing Considerations

Consideration of co-existing conditions such as tension-type headaches or cluster headaches.

Primary Care

Documentation Requirements

Comprehensive patient history, including lifestyle factors and trigger identification.

Common Clinical Scenarios

Patients seeking management for chronic headaches or migraines.

Billing Considerations

Coordination of care with specialists for complex cases.

Coding Guidelines

Inclusion Criteria

Use G43.00 When
  • According to ICD
  • 10 guidelines, G43
  • 00 should be used when the patient presents with migraine without aura that is not intractable
  • It is important to document the frequency, duration, and severity of headaches, as well as any associated symptoms

Exclusion Criteria

Do NOT use G43.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for migraine management.

Documentation Requirements

Document history of present illness, review of systems, and treatment plan.

Specialty Considerations

Neurologists may require more detailed neurological examinations.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of migraine types, improving the accuracy of data collection and treatment planning. G43.00 provides a clear distinction for migraines without aura, facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of migraine types, improving the accuracy of data collection and treatment planning. G43.00 provides a clear distinction for migraines without aura, facilitating better patient management.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

What is the difference between G43.00 and G43.01?

G43.00 is used for migraines without aura, while G43.01 is for migraines with aura. The presence of aura symptoms is the key differentiator.