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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.1

G43.1

Billable

Migraine with aura

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

Code Description

ICD-10 G43.1 is a billable code used to indicate a diagnosis of migraine with aura.

Key Diagnostic Point:

Migraine with aura is a type of migraine characterized by the presence of neurological symptoms that precede or accompany the headache phase. These aura symptoms can include visual disturbances such as flashing lights, zigzag patterns, or blind spots, as well as sensory changes like tingling or numbness. The aura typically lasts from 5 to 60 minutes and is followed by a headache that can last from 4 to 72 hours. The headache is often unilateral, pulsating, and may be accompanied by nausea, vomiting, and sensitivity to light and sound. The exact pathophysiology of migraine with aura is not fully understood, but it is believed to involve cortical spreading depression and changes in cerebral blood flow. Triggers for migraines with aura can include stress, hormonal changes, certain foods, and environmental factors. Preventive treatments may involve lifestyle modifications, pharmacological interventions such as beta-blockers, anticonvulsants, or CGRP inhibitors, and addressing specific triggers to reduce the frequency and severity of migraine attacks.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between migraine types (with and without aura)
  • Identifying and documenting specific aura symptoms
  • Understanding the patient's history of migraine episodes
  • Recognizing potential comorbid conditions

Audit Risk Factors

  • Inadequate documentation of aura symptoms
  • Failure to document the frequency and duration of migraines
  • Misclassification of migraine types
  • Lack of evidence for preventive treatment plans

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed documentation of aura symptoms, headache characteristics, and treatment history.

Common Clinical Scenarios

Patients presenting with recurrent headaches, aura symptoms, and varying response to treatments.

Billing Considerations

Ensure accurate differentiation between migraine types and other headache disorders.

Primary Care

Documentation Requirements

Comprehensive patient history, including triggers and lifestyle factors.

Common Clinical Scenarios

Patients seeking management for chronic headaches and discussing preventive strategies.

Billing Considerations

Coordination with specialists for complex cases and ensuring follow-up on treatment efficacy.

Coding Guidelines

Inclusion Criteria

Use G43.1 When
  • According to ICD
  • 10 guidelines, G43
  • 1 should be used when a patient has a documented history of migraines with aura
  • It is essential to include details about the aura symptoms and their duration

Exclusion Criteria

Do NOT use G43.1 When
  • Exclusion criteria include migraines without aura and other headache disorders

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 the patient's history, current symptoms, 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 diagnoses and treatment plans. G43.1 provides a clear distinction for migraines with aura, facilitating better patient management and research.

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. G43.1 provides a clear distinction for migraines with aura, facilitating better patient management and research.

Reimbursement & Billing Impact

impact of migraines on daily activities can support the medical necessity of treatments.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

What are the common triggers for migraines with aura?

Common triggers include stress, hormonal changes, certain foods (like aged cheese and processed meats), caffeine, alcohol, and environmental factors such as bright lights or strong smells.