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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.511

G43.511

Billable

Persistent migraine aura without cerebral infarction, intractable, with status migrainosus

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

Code Description

ICD-10 G43.511 is a billable code used to indicate a diagnosis of persistent migraine aura without cerebral infarction, intractable, with status migrainosus.

Key Diagnostic Point:

G43.511 refers to a specific type of migraine characterized by persistent aura symptoms that do not lead to cerebral infarction. This condition is classified as intractable, meaning it is resistant to standard treatment protocols, and is associated with status migrainosus, a severe form of migraine that lasts longer than 72 hours. Patients may experience prolonged visual disturbances, sensory changes, and other neurological symptoms that can significantly impair daily functioning. The intractable nature of this condition often necessitates a multidisciplinary approach to management, including pharmacological interventions, lifestyle modifications, and possibly alternative therapies. Understanding triggers such as stress, hormonal changes, dietary factors, and environmental stimuli is crucial for effective management. Preventive treatments may include medications like beta-blockers, anticonvulsants, or CGRP inhibitors, tailored to the individual patient's needs.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Intractable nature complicates treatment documentation.
  • Persistent aura symptoms require detailed clinical descriptions.
  • Differentiation from other migraine types is essential.
  • Status migrainosus requires specific management protocols.

Audit Risk Factors

  • Insufficient documentation of aura symptoms.
  • Lack of evidence for intractability.
  • Failure to document treatment attempts.
  • Inadequate differentiation from other headache disorders.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed history of migraine episodes, aura characteristics, and treatment responses.

Common Clinical Scenarios

Patients presenting with prolonged aura symptoms and severe headache.

Billing Considerations

Ensure thorough documentation of neurological examinations and treatment plans.

Primary Care

Documentation Requirements

Comprehensive patient history, including triggers and response to preventive treatments.

Common Clinical Scenarios

Patients with recurrent migraines seeking preventive strategies.

Billing Considerations

Document lifestyle factors and patient education on migraine management.

Coding Guidelines

Inclusion Criteria

Use G43.511 When
  • Follow official ICD
  • 10 guidelines for migraine coding, ensuring accurate documentation of symptoms, treatment history, and the intractable nature of the condition
  • Include specific details about the aura and its persistence

Exclusion Criteria

Do NOT use G43.511 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 history of present illness, examination findings, and treatment plan.

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 tracking. G43.511 provides a clear distinction for intractable cases, which can impact treatment reimbursement and management strategies.

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 tracking. G43.511 provides a clear distinction for intractable cases, which can impact treatment reimbursement and management strategies.

Reimbursement & Billing Impact

reimbursement and management strategies.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

What distinguishes G43.511 from other migraine codes?

G43.511 specifically refers to persistent migraine aura without cerebral infarction that is intractable and associated with status migrainosus, requiring detailed documentation of symptoms and treatment.