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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.9

G43.9

Billable

Migraine, unspecified

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

Code Description

ICD-10 G43.9 is a billable code used to indicate a diagnosis of migraine, unspecified.

Key Diagnostic Point:

Migraine is a common and debilitating headache disorder characterized by recurrent episodes of moderate to severe headache, often accompanied by nausea, vomiting, and sensitivity to light and sound. The exact pathophysiology of migraines is complex and involves neurovascular mechanisms, including the release of inflammatory mediators and changes in cerebral blood flow. Migraines can be triggered by various factors, including hormonal changes, stress, certain foods, and environmental stimuli. The unspecified designation indicates that the specific type of migraine (e.g., migraine without aura, migraine with aura) has not been documented. This code is often used when the clinician has not specified the type of migraine, making it essential for coders to ensure that documentation is as detailed as possible to avoid ambiguity. Treatment options include acute medications for pain relief and preventive therapies aimed at reducing the frequency and severity of attacks. Preventive treatments may include lifestyle modifications, dietary changes, and pharmacological interventions such as beta-blockers, anticonvulsants, and antidepressants.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in migraine presentation and triggers
  • Need for detailed patient history to identify triggers
  • Differentiation from other headache types
  • Documentation of treatment response and follow-up

Audit Risk Factors

  • Inadequate documentation of migraine type
  • Failure to document triggers or treatment plans
  • Use of unspecified codes without justification
  • Inconsistent coding across encounters

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed patient history, including headache frequency, duration, and associated symptoms.

Common Clinical Scenarios

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

Billing Considerations

Ensure that the type of migraine is documented when possible to avoid using unspecified codes.

Primary Care

Documentation Requirements

Comprehensive assessment of headache history and potential triggers.

Common Clinical Scenarios

Patients with episodic migraines seeking management or preventive treatment.

Billing Considerations

Document lifestyle factors and response to treatments to support coding.

Coding Guidelines

Inclusion Criteria

Use G43.9 When
  • According to ICD
  • 10 coding guidelines, G43
  • 9 should be used when the specific type of migraine is not documented
  • Coders should ensure that all relevant clinical information is captured to support the use of this code

Exclusion Criteria

Do NOT use G43.9 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 of neurological examinations.

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, but the use of unspecified codes like G43.9 remains common. Coders must ensure that documentation supports the use of this code to avoid potential audits.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of migraine types, but the use of unspecified codes like G43.9 remains common. Coders must ensure that documentation supports the use of this code to avoid potential audits.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of migraine types, but the use of unspecified codes like G43.9 remains common. Coders must ensure that documentation supports the use of this code to avoid potential audits.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

When should I use G43.9?

Use G43.9 when the specific type of migraine has not been documented, and ensure that all relevant clinical information is captured to support this coding.