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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.001

G43.001

Billable

Migraine without aura, not intractable, with status migrainosus

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

Code Description

ICD-10 G43.001 is a billable code used to indicate a diagnosis of migraine without aura, not intractable, with status migrainosus.

Key Diagnostic Point:

Migraine without aura, classified under G43.001, refers to a type of migraine headache that occurs without the preceding sensory disturbances known as aura. This condition is characterized by recurrent episodes of moderate to severe headache, typically unilateral, pulsating in nature, and often accompanied by nausea, vomiting, and sensitivity to light and sound. The term 'status migrainosus' indicates that the migraine has persisted for more than 72 hours, leading to significant impairment in daily functioning. Unlike intractable migraines, which are resistant to treatment, this code is used for migraines that, while severe and prolonged, can still be managed with appropriate interventions. Triggers for these migraines may include stress, hormonal changes, certain foods, and environmental factors. Preventive treatments may involve lifestyle modifications, pharmacological interventions such as beta-blockers, anticonvulsants, or antidepressants, and the use of CGRP inhibitors. Accurate coding is essential for appropriate treatment planning and insurance reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between intractable and non-intractable migraines
  • Identifying the presence of status migrainosus
  • Documenting the duration and severity of the migraine
  • Recognizing associated symptoms and triggers

Audit Risk Factors

  • Inadequate documentation of migraine duration
  • Failure to specify status migrainosus
  • Lack of evidence for treatment attempts
  • Misclassification of migraine type

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed headache history, including frequency, duration, and associated symptoms.

Common Clinical Scenarios

Patients presenting with severe headaches lasting several days, requiring hospitalization.

Billing Considerations

Ensure documentation reflects the severity and impact on daily activities.

Primary Care

Documentation Requirements

Comprehensive patient history and response to previous treatments.

Common Clinical Scenarios

Patients with recurrent migraines seeking preventive treatment options.

Billing Considerations

Document lifestyle factors and triggers that may contribute to migraine episodes.

Coding Guidelines

Inclusion Criteria

Use G43.001 When
  • According to ICD
  • 10 guidelines, G43
  • 001 should be used when the migraine is documented as not intractable and has lasted longer than 72 hours
  • It is important to include details about the patient's history and treatment response to support the diagnosis

Exclusion Criteria

Do NOT use G43.001 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99214CPT Code

Established patient office visit, level 4

Clinical Scenario

Used for follow-up visits for migraine management.

Documentation Requirements

Document the patient's migraine history, treatment response, and any changes in symptoms.

Specialty Considerations

Neurologists may require more detailed neurological assessments.

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 diagnoses and treatment plans. G43.001 provides a clear distinction for migraines without aura, enhancing patient care and billing processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of migraine types, improving the accuracy of diagnoses and treatment plans. G43.001 provides a clear distinction for migraines without aura, enhancing patient care and billing processes.

Reimbursement & Billing Impact

billing processes.

Resources

Clinical References

  • •
    International Classification of Headache Disorders

Coding & Billing References

  • •
    International Classification of Headache Disorders

Frequently Asked Questions

What is the difference between intractable and non-intractable migraines?

Intractable migraines are those that do not respond to standard treatments and persist despite multiple interventions, while non-intractable migraines can be managed effectively with appropriate care.