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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.101

G43.101

Billable

Migraine with aura, not intractable, with status migrainosus

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

Code Description

ICD-10 G43.101 is a billable code used to indicate a diagnosis of migraine with aura, not intractable, with status migrainosus.

Key Diagnostic Point:

Migraine with aura is characterized by the presence of neurological symptoms that precede or accompany the headache phase of the migraine. These symptoms can include visual disturbances, sensory changes, and speech difficulties. Status migrainosus refers to a severe migraine attack that lasts longer than 72 hours, which can lead to significant disability and may require hospitalization. The term 'not intractable' indicates that the migraine is manageable with appropriate treatment, distinguishing it from more severe forms that do not respond to standard therapies. Patients may experience 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 attacks.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of migraines (with aura vs. without aura)
  • Understanding the distinction between intractable and non-intractable migraines
  • Identifying the presence of status migrainosus
  • Documenting the duration and severity of the migraine

Audit Risk Factors

  • Inadequate documentation of aura symptoms
  • Failure to document the duration of the migraine episode
  • Misclassification of migraine severity
  • Lack of evidence for preventive treatment attempts

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed history of migraine episodes, including frequency, duration, and associated symptoms.

Common Clinical Scenarios

Patients presenting with recurrent migraines, particularly those with aura and prolonged episodes.

Billing Considerations

Ensure thorough documentation of aura symptoms and treatment response.

Primary Care

Documentation Requirements

Comprehensive patient history and lifestyle factors that may contribute to migraines.

Common Clinical Scenarios

Patients seeking management for chronic migraines and preventive strategies.

Billing Considerations

Document lifestyle modifications and patient education efforts.

Coding Guidelines

Inclusion Criteria

Use G43.101 When
  • According to ICD
  • 10 guidelines, G43
  • 101 should be used when a patient has a documented migraine with aura that is not intractable and has experienced status migrainosus
  • It is essential to document the presence of aura and the duration of the migraine episode

Exclusion Criteria

Do NOT use G43.101 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 migraine history, treatment response, and any new symptoms.

Specialty Considerations

Neurology 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 diagnoses and treatment plans. G43.101 provides a clear distinction for migraines with aura and status migrainosus, 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. G43.101 provides a clear distinction for migraines with aura and status migrainosus, facilitating better patient management.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    International Classification of Headache Disorders

Coding & Billing References

  • •
    International Classification of Headache Disorders

Frequently Asked Questions

What distinguishes G43.101 from other migraine codes?

G43.101 specifically refers to migraines with aura that are not intractable and have resulted in status migrainosus, requiring detailed documentation of symptoms and treatment.