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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.009

G43.009

Billable

Migraine without aura, not intractable, without status migrainosus

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

Code Description

ICD-10 G43.009 is a billable code used to indicate a diagnosis of migraine without aura, not intractable, without status migrainosus.

Key Diagnostic Point:

Migraine without aura is a common type of headache disorder characterized by recurrent episodes of moderate to severe headache, typically unilateral, pulsating in quality, and often accompanied by nausea, vomiting, and sensitivity to light and sound. This specific code, G43.009, refers to migraines that are not classified as intractable, meaning they are manageable and do not require emergency intervention. Additionally, it excludes status migrainosus, a severe form of migraine lasting more than 72 hours. Triggers for migraines can vary widely among individuals and may include stress, hormonal changes, certain foods, and environmental factors. Preventive treatments may include lifestyle modifications, pharmacological interventions such as beta-blockers, anticonvulsants, and antidepressants, as well as newer therapies like CGRP inhibitors. Accurate coding is essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in migraine triggers and symptoms among patients
  • Differentiation from other headache types
  • Need for detailed patient history and documentation
  • Potential overlap with other migraine-related codes

Audit Risk Factors

  • Inadequate documentation of migraine frequency and severity
  • Failure to specify the absence of aura
  • Misclassification of intractable migraines
  • Lack of documentation for preventive treatments

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

Neurologists must document the absence of aura and the effectiveness of preventive treatments.

Primary Care

Documentation Requirements

Comprehensive documentation of patient-reported symptoms and response to treatment.

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 intractable.

Coding Guidelines

Inclusion Criteria

Use G43.009 When
  • According to ICD
  • 10 guidelines, G43
  • 009 should be used when a patient has a documented history of migraines without aura, is not experiencing intractable symptoms, and does not meet criteria for status migrainosus
  • Documentation must support the diagnosis and treatment plan

Exclusion Criteria

Do NOT use G43.009 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, treatment response, and any changes in symptoms.

Specialty Considerations

Neurologists may require more detailed documentation compared to primary care.

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 diagnosis and treatment tracking. G43.009 provides a clear distinction for migraines without aura, 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 diagnosis and treatment tracking. G43.009 provides a clear distinction for migraines without aura, 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 G43.009 and G43.001?

G43.009 is used for migraines without aura, while G43.001 is for migraines with aura. Accurate documentation of symptoms is crucial for proper coding.