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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.809

G43.809

Billable

Other migraine, not intractable, without status migrainosus

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

Code Description

ICD-10 G43.809 is a billable code used to indicate a diagnosis of other migraine, not intractable, without status migrainosus.

Key Diagnostic Point:

G43.809 refers to a type of migraine that does not fall into the more common categories of migraine with aura or migraine without aura. This code is used for patients experiencing migraine episodes that are not classified as intractable, meaning they are manageable and do not lead to prolonged or severe symptoms that require emergency intervention. Patients may experience varying degrees of headache intensity, associated symptoms such as nausea, photophobia, and phonophobia, but these episodes do not meet the criteria for status migrainosus, which is defined as a migraine attack lasting longer than 72 hours. Triggers for these migraines can include stress, hormonal changes, dietary factors, and environmental stimuli. Preventive treatments may include lifestyle modifications, pharmacological interventions such as beta-blockers, anticonvulsants, or antidepressants, and alternative therapies like acupuncture or biofeedback. Accurate coding is essential for appropriate treatment planning and insurance reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of migraine types and subtypes
  • Overlap with other headache disorders
  • Need for detailed patient history to identify triggers
  • Variability in treatment approaches

Audit Risk Factors

  • Inadequate documentation of migraine characteristics
  • Failure to specify triggers or preventive measures
  • Misclassification of migraine type
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with recurrent headaches, requiring differentiation from other headache types.

Billing Considerations

Neurologists must ensure that all migraine characteristics are documented to support the use of G43.809.

Primary Care

Documentation Requirements

Comprehensive records of patient symptoms, lifestyle factors, and any prescribed preventive treatments.

Common Clinical Scenarios

Patients with episodic migraines seeking management strategies.

Billing Considerations

Primary care providers should be aware of the need for referrals to specialists if migraines are frequent or severe.

Coding Guidelines

Inclusion Criteria

Use G43.809 When
  • According to ICD
  • 10 guidelines, G43
  • 809 should be used when the migraine is not classified as intractable and does not meet the criteria for status migrainosus
  • Documentation must clearly indicate the nature of the migraine and any associated symptoms

Exclusion Criteria

Do NOT use G43.809 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 the patient's history, 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. G43.809 provides a clear distinction for non-intractable migraines, 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 diagnoses and treatment plans. G43.809 provides a clear distinction for non-intractable migraines, facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of migraine types, improving the accuracy of diagnoses and treatment plans. G43.809 provides a clear distinction for non-intractable migraines, facilitating better patient management.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

What distinguishes G43.809 from other migraine codes?

G43.809 is specifically for other types of migraines that are not classified as intractable and do not involve status migrainosus, allowing for targeted treatment and management.