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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.909

G43.909

Billable

Migraine, unspecified, not intractable, without status migrainosus

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

Code Description

ICD-10 G43.909 is a billable code used to indicate a diagnosis of migraine, unspecified, not intractable, without status migrainosus.

Key Diagnostic Point:

G43.909 refers to a type of migraine headache that is not classified as intractable and does not involve status migrainosus, which is a severe and prolonged migraine attack. This code is used when the specific type of migraine is not clearly defined, and the patient experiences recurrent headaches that may be moderate to severe in intensity. Migraines can be triggered by various factors, including stress, hormonal changes, certain foods, and environmental stimuli. Patients may experience symptoms such as nausea, vomiting, and sensitivity to light and sound. The condition can significantly impact daily activities and quality of life. Treatment options typically include acute medications for pain relief and preventive therapies to reduce the frequency and severity of attacks. Preventive treatments may include lifestyle modifications, dietary changes, and pharmacological interventions such as beta-blockers, anticonvulsants, or antidepressants. Accurate coding is essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in migraine presentation and triggers
  • Need for detailed patient history to determine appropriate coding
  • Differentiation from other headache disorders
  • Potential for overlapping symptoms with other conditions

Audit Risk Factors

  • Insufficient documentation of migraine frequency and severity
  • Lack of clarity on triggers and patient history
  • Inconsistent use of terminology in clinical notes
  • Failure to document preventive treatment attempts

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 tension-type headaches or cluster headaches.

Billing Considerations

Neurologists should document any neurological examinations and response to treatments to support coding.

Primary Care

Documentation Requirements

Comprehensive documentation of patient symptoms, triggers, and any previous treatments attempted.

Common Clinical Scenarios

Patients with episodic migraines seeking management or preventive strategies.

Billing Considerations

Primary care providers should ensure thorough documentation of lifestyle factors and patient education on migraine management.

Coding Guidelines

Inclusion Criteria

Use G43.909 When
  • According to ICD
  • 10 guidelines, G43
  • 909 should be used when the migraine type is unspecified and not intractable
  • It is essential to document the absence of status migrainosus and any relevant patient history to support the diagnosis

Exclusion Criteria

Do NOT use G43.909 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 patient history, review of systems, and treatment plan.

Specialty Considerations

Ensure that the visit is clearly documented as related to migraine management.

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. G43.909 provides a clear classification for unspecified migraines, facilitating 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. G43.909 provides a clear classification for unspecified migraines, facilitating 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 G43.909 and G43.901?

G43.909 is used for unspecified migraines that are not intractable, while G43.901 is for intractable migraines, which require more intensive management and documentation of treatment failures.