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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.109

G43.109

Billable

Migraine with aura, not intractable, without status migrainosus

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

Code Description

ICD-10 G43.109 is a billable code used to indicate a diagnosis of migraine with aura, not intractable, without status migrainosus.

Key Diagnostic Point:

Migraine with aura is characterized by recurrent headaches that are often preceded or accompanied by sensory disturbances known as aura. These auras can manifest as visual disturbances (such as flashing lights or blind spots), sensory changes (like tingling or numbness), or speech difficulties. The headaches typically occur on one side of the head and can be moderate to severe in intensity, often exacerbated by physical activity. This specific code, G43.109, is used for migraines that are not intractable, meaning they are manageable and do not lead to prolonged or severe episodes that require emergency intervention (status migrainosus). Triggers for migraines with aura can include stress, hormonal changes, certain foods, and environmental factors. Preventive treatments may involve lifestyle modifications, medications such as beta-blockers, anticonvulsants, or antidepressants, and the use of CGRP inhibitors. Accurate coding is essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between migraine types (with and without aura)
  • Identifying triggers and their documentation
  • Understanding the distinction between intractable and non-intractable migraines
  • Properly documenting the absence of status migrainosus

Audit Risk Factors

  • Inadequate documentation of aura symptoms
  • Failure to specify the non-intractable nature of the migraine
  • Misclassification of migraine type
  • Lack of documented triggers or preventive measures

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed patient history, including frequency and duration of migraines, aura symptoms, and response to treatments.

Common Clinical Scenarios

Patients presenting with recurrent migraines, requiring evaluation of aura symptoms and treatment plans.

Billing Considerations

Neurologists must ensure comprehensive documentation to support the diagnosis and treatment plan.

Primary Care

Documentation Requirements

Thorough documentation of patient-reported symptoms, triggers, and any prescribed preventive medications.

Common Clinical Scenarios

Patients seeking management for migraine headaches, including lifestyle modifications and medication management.

Billing Considerations

Primary care providers should be aware of the need for referral to specialists if migraines are not well-managed.

Coding Guidelines

Inclusion Criteria

Use G43.109 When
  • According to ICD
  • 10 guidelines, G43
  • 109 should be used when the patient has a documented history of migraines with aura that are not classified as intractable
  • It is essential to document the absence of status migrainosus and any relevant triggers or preventive treatments

Exclusion Criteria

Do NOT use G43.109 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 patient history, treatment response, and any changes in symptoms.

Specialty Considerations

Neurologists may require more detailed documentation compared to primary care providers.

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 diagnosis and treatment tracking. G43.109 provides a clear distinction for migraines with 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 diagnosis and treatment tracking. G43.109 provides a clear distinction for migraines with aura, facilitating better patient management.

Reimbursement & Billing Impact

reimbursement and to justify the medical necessity of services provided.

Resources

Clinical References

  • •
    International Classification of Headache Disorders

Coding & Billing References

  • •
    International Classification of Headache Disorders

Frequently Asked Questions

What distinguishes G43.109 from other migraine codes?

G43.109 specifically refers to migraines with aura that are not intractable, meaning they are manageable and do not lead to prolonged episodes requiring emergency care.