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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.901

G43.901

Billable

Migraine, unspecified, not intractable, with status migrainosus

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

Code Description

ICD-10 G43.901 is a billable code used to indicate a diagnosis of migraine, unspecified, not intractable, with status migrainosus.

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 term 'status migrainosus' refers to a severe migraine attack that lasts longer than 72 hours, which can lead to significant disability and may require hospitalization. This specific code, G43.901, is used when the migraine is unspecified and not classified as intractable, meaning that it is manageable with standard treatments. Patients may experience various triggers such as stress, hormonal changes, certain foods, and environmental factors. Preventive treatments may include medications such as beta-blockers, anticonvulsants, and antidepressants, as well as lifestyle modifications to reduce the frequency and severity of migraine attacks. Accurate coding is essential for appropriate treatment and reimbursement, as well as for tracking the prevalence and impact of migraine disorders in the population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in migraine presentation and triggers
  • Differentiation from other headache types
  • Need for detailed patient history and documentation
  • Potential for co-existing conditions affecting treatment

Audit Risk Factors

  • Inadequate documentation of migraine duration
  • Failure to specify triggers or associated symptoms
  • 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 severity of migraines, as well as any triggers and response to treatments.

Common Clinical Scenarios

Patients presenting with recurrent migraines, status migrainosus requiring hospitalization, and those needing preventive therapy.

Billing Considerations

Neurologists must document the impact of migraines on daily functioning and any comorbid conditions.

Primary Care

Documentation Requirements

Comprehensive assessment of headache history, lifestyle factors, and any previous treatments attempted.

Common Clinical Scenarios

Patients seeking management for chronic migraines, referrals to specialists, and those requiring lifestyle modification advice.

Billing Considerations

Primary care providers should ensure thorough documentation of patient education and follow-up plans.

Coding Guidelines

Inclusion Criteria

Use G43.901 When
  • According to ICD
  • 10 guidelines, G43
  • 901 should be used when the migraine is not specified as intractable and is accompanied by status migrainosus
  • Coders must ensure that documentation supports the diagnosis and that the condition is not better described by another code

Exclusion Criteria

Do NOT use G43.901 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 the patient's history, 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 data collection and treatment tracking. G43.901 provides a clear distinction for migraines with status migrainosus, which was less defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of migraine types, improving the accuracy of data collection and treatment tracking. G43.901 provides a clear distinction for migraines with status migrainosus, which was less defined in ICD-9.

Reimbursement & Billing Impact

impact on the patient's daily life. Providers should ensure that all relevant information is included in the medical record to support the diagnosis.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

What is the difference between G43.901 and G43.909?

G43.901 is used for migraines with status migrainosus, while G43.909 is for unspecified migraines without this complication.