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v1.0.0
ICD-10 Guide
ICD-10 CodesG43.90

G43.90

Billable

Migraine, unspecified, not intractable

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

Code Description

ICD-10 G43.90 is a billable code used to indicate a diagnosis of migraine, unspecified, not intractable.

Key Diagnostic Point:

Migraine is a common type of headache disorder characterized by recurrent episodes of moderate to severe headache, often accompanied by nausea, vomiting, and sensitivity to light and sound. The unspecified designation indicates that the specific type of migraine has not been determined, which may include migraine without aura or migraine with aura. Not intractable means that the migraine episodes are manageable and do not require aggressive treatment measures. 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, or antidepressants, and the use of CGRP inhibitors. Accurate diagnosis and coding are essential for effective treatment and management of migraines, as they can significantly impact a patient's quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in migraine presentation and triggers
  • Need for detailed patient history to identify specific types
  • Differentiation from other headache disorders
  • Documentation of treatment response and preventive measures

Audit Risk Factors

  • Inadequate documentation of migraine triggers
  • Failure to document treatment response
  • Misclassification of migraine type
  • Lack of follow-up notes on migraine management

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 imaging studies performed to rule out secondary causes of headaches.

Primary Care

Documentation Requirements

Comprehensive history and physical examination, including lifestyle factors and potential triggers.

Common Clinical Scenarios

Patients seeking management for chronic headaches or migraines, often requiring referrals to specialists.

Billing Considerations

Primary care providers should ensure continuity of care and document any referrals or follow-up plans.

Coding Guidelines

Inclusion Criteria

Use G43.90 When
  • According to ICD
  • 10 guidelines, G43
  • 90 should be used when the specific type of migraine is not documented
  • Coders should ensure that the documentation supports the diagnosis and that the migraine is not classified as intractable

Exclusion Criteria

Do NOT use G43.90 When
  • Exclusion criteria include migraines that are secondary to other medical conditions

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 additional documentation of neurological assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding migraines, enabling better tracking of treatment outcomes and healthcare utilization. G43.90 reflects the need for coders to accurately capture the nuances of migraine presentations.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding migraines, enabling better tracking of treatment outcomes and healthcare utilization. G43.90 reflects the need for coders to accurately capture the nuances of migraine presentations.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding migraines, enabling better tracking of treatment outcomes and healthcare utilization. G43.90 reflects the need for coders to accurately capture the nuances of migraine presentations.

Resources

Clinical References

  • •
    American Migraine Foundation

Coding & Billing References

  • •
    American Migraine Foundation

Frequently Asked Questions

When should I use G43.90 instead of a more specific migraine code?

G43.90 should be used when the specific type of migraine is not documented or when the provider has not specified the migraine type, but the patient has a history of migraines that are not intractable.