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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.801

G43.801

Billable

Other migraine, not intractable, with status migrainosus

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

Code Description

ICD-10 G43.801 is a billable code used to indicate a diagnosis of other migraine, not intractable, with status migrainosus.

Key Diagnostic Point:

G43.801 refers to a specific type of migraine that is characterized by prolonged migraine attacks lasting more than 72 hours, known as status migrainosus. This condition is not classified as intractable, meaning it is not resistant to treatment. Patients may experience severe, unilateral or bilateral headache, often accompanied by nausea, vomiting, photophobia, and phonophobia. The diagnosis of status migrainosus requires careful clinical evaluation to differentiate it from other headache disorders. Triggers for these migraines can 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 management and reimbursement, as it reflects the severity and complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other types of migraines and headache disorders
  • Need for detailed documentation of symptoms and duration
  • Potential overlap with intractable migraine codes
  • Variability in treatment responses and preventive measures

Audit Risk Factors

  • Inadequate documentation of migraine duration and severity
  • Failure to identify and document triggers
  • Misclassification of migraine type
  • Lack of evidence for preventive treatment attempts

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed patient history, including frequency, duration, and characteristics of migraines, as well as response to treatments.

Common Clinical Scenarios

Patients presenting with recurrent migraines, status migrainosus, or those requiring preventive therapy.

Billing Considerations

Neurologists should ensure comprehensive documentation of all migraine episodes and treatments to support coding.

Primary Care

Documentation Requirements

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

Common Clinical Scenarios

Patients with episodic migraines seeking management or those with chronic migraines requiring referral to a specialist.

Billing Considerations

Primary care providers should document any lifestyle factors and patient education provided regarding migraine management.

Coding Guidelines

Inclusion Criteria

Use G43.801 When
  • According to ICD
  • 10 guidelines, G43
  • 801 should be used when the migraine is not intractable and is characterized by prolonged episodes
  • It is essential to document the duration of the migraine and any associated symptoms to support the diagnosis

Exclusion Criteria

Do NOT use G43.801 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 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 diagnoses and treatment plans. G43.801 provides a clear distinction for status migrainosus, which aids in better patient management and reimbursement 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. G43.801 provides a clear distinction for status migrainosus, which aids in better patient management and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

What is the difference between G43.801 and G43.009?

G43.801 is specifically for other migraines that are not intractable and are characterized by status migrainosus, while G43.009 is used for unspecified migraines that do not meet the criteria for other specific types.