ICD-10 Coding for Migraine Headache(G43.0, G43.1, G43.7, G43.E)
Complete ICD-10-CM coding and documentation guide for Migraine Headache. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Migraine Headache
G43.0-G43.9Primary Range
Migraine
This range covers all types of migraines, including those with and without aura, chronic migraines, and status migrainosus.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G43.0 | Migraine without aura | Use when the patient experiences migraines without any sensory or visual aura. |
|
| G43.1 | Migraine with aura | Use when the patient experiences migraines with sensory or visual aura. |
|
| G43.7 | Chronic migraine without aura | Use for chronic migraines without aura, meeting frequency criteria. |
|
| G43.E | Chronic migraine with aura | Use for chronic migraines with aura, meeting frequency criteria. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for migraine headache
Essential facts and insights about Migraine Headache
Primary ICD-10-CM Codes for migraine headache
Decision Criteria
clinical Criteria
- Headache without preceding aura symptoms.
Applicable To
- Common migraine
Excludes
- Migraine with aura (G43.1-)
Clinical Validation Requirements
- Unilateral headache
- Nausea
- Photophobia
Code-Specific Risks
- Ensure no aura is documented before using this code.
Coding Notes
- Ensure documentation specifies absence of aura.
G43.1 - Migraine with aura
Use when the patient experiences migraines with sensory or visual aura.
Applicable To
- Classic migraine
Excludes
- Migraine without aura (G43.0-)
Clinical Validation Requirements
- Visual or sensory aura
- Headache follows aura
Coding Notes
Aura must be documented in the patient's record.
G43.7 - Chronic migraine without aura
Use for chronic migraines without aura, meeting frequency criteria.
Applicable To
- Chronic migraine
Excludes
- Chronic migraine with aura (G43.E-)
Clinical Validation Requirements
- ≥15 headache days/month
- ≥3 months duration
Coding Notes
Document frequency and duration explicitly.
G43.E - Chronic migraine with aura
Use for chronic migraines with aura, meeting frequency criteria.
Applicable To
- Chronic migraine with aura
Excludes
- Chronic migraine without aura (G43.7-)
Clinical Validation Requirements
- ≥15 headache days/month
- Aura symptoms present
Coding Notes
Document both frequency and aura details.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Migraine Headache to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G43.0.
Impact
Clinical: Misclassification of migraine type., Regulatory: Potential audit issues., Financial: Claim denials due to insufficient documentation.
Mitigation Strategy
Include detailed aura descriptions in notes.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify and document that no aura symptoms are present.
Impact
Inaccurate coding due to insufficient documentation of chronicity.
Mitigation Strategy
Use headache diaries to track frequency and duration.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Migraine Headache, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Migraine Headache
Use these documentation templates to ensure complete and accurate documentation for Migraine Headache. These templates include all required elements for proper coding and billing.
Chronic Migraine Documentation
Specialty: NeurologyRequired Elements
- Headache frequency
- Aura description
- Treatment response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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