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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.411

G43.411

Billable

Hemiplegic migraine, intractable, with status migrainosus

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

Code Description

ICD-10 G43.411 is a billable code used to indicate a diagnosis of hemiplegic migraine, intractable, with status migrainosus.

Key Diagnostic Point:

Hemiplegic migraine is a rare and severe form of migraine characterized by temporary paralysis or weakness on one side of the body (hemiplegia) that can occur before, during, or after a migraine attack. The intractable nature of this condition indicates that the migraine is resistant to standard treatments and persists for an extended period, often leading to status migrainosus, a debilitating condition where a migraine lasts longer than 72 hours. Patients may experience aura symptoms, including visual disturbances, sensory changes, and motor weakness. The pathophysiology involves complex neurovascular mechanisms, including cortical spreading depression and alterations in cerebral blood flow. Triggers can include stress, hormonal changes, certain foods, and environmental factors. Preventive treatments may involve medications such as beta-blockers, anticonvulsants, or CGRP inhibitors, and lifestyle modifications to reduce the frequency and severity of attacks.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Intractable nature complicates treatment options.
  • Requires thorough documentation of symptoms and triggers.
  • Differentiation from other types of migraines is essential.
  • Potential overlap with other neurological conditions.

Audit Risk Factors

  • Inadequate documentation of intractability.
  • Failure to document the duration of the migraine.
  • Lack of evidence for treatment attempts.
  • Misclassification of migraine type.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with recurrent severe migraines, neurological deficits, or prolonged migraine episodes.

Billing Considerations

Neurologists must document the neurological examination findings and any imaging studies performed.

Pain Management

Documentation Requirements

Comprehensive pain assessments, treatment plans, and response to interventions.

Common Clinical Scenarios

Patients with chronic migraine requiring multimodal pain management strategies.

Billing Considerations

Pain specialists should document the effectiveness of various pain management techniques and any side effects experienced by the patient.

Coding Guidelines

Inclusion Criteria

Use G43.411 When
  • Follow the official ICD
  • CM coding guidelines for migraines, ensuring accurate documentation of the patient's symptoms, treatment history, and any associated conditions
  • Include details on the intractable nature and status migrainosus

Exclusion Criteria

Do NOT use G43.411 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 patients with chronic migraines.

Documentation Requirements

Document the patient's history, examination findings, and treatment plan.

Specialty Considerations

Neurologists should ensure detailed documentation of 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, including hemiplegic migraines, which aids in better tracking and management of these complex conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of migraine types, including hemiplegic migraines, which aids in better tracking and management of these complex conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of migraine types, including hemiplegic migraines, which aids in better tracking and management of these complex conditions.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

What distinguishes hemiplegic migraine from other migraine types?

Hemiplegic migraine is characterized by temporary paralysis or weakness on one side of the body, which is not seen in other migraine types. It also has a genetic component and can be more severe and prolonged.