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ICD-10 Coding for Migraine Without Aura(G43.009, G43.709)

Complete ICD-10-CM coding and documentation guide for Migraine Without Aura. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Common MigraineMigraine Headache

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Related ICD-10 Code Ranges

Complete code families applicable to Migraine Without Aura

G43.0-G43.9Primary Range

Migraine

This range includes all types of migraines, with G43.0 specifically for migraines without aura.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
G43.009Migraine without aura, not intractable, without status migrainosusUse for acute episodic migraines without aura that are not intractable and do not have status migrainosus.
  • ≥5 attacks
  • Headache lasting 4-72 hours
  • Unilateral, pulsating pain
  • + 1 more
G43.709Chronic migraine without aura, not intractableUse for chronic migraines without aura that are not intractable.
  • ≥15 headache days/month
  • ≥8 migraine days/month
  • Duration over 3 months

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 without aura

Essential facts and insights about Migraine Without Aura

The ICD-10 code for migraine without aura is G43.009 for episodic and G43.709 for chronic cases.

Primary ICD-10-CM Codes for migraine without aura

G43.009
Migraine without aura, not intractable, without status migrainosus
Billable Code

Decision Criteria

clinical Criteria

  • Headache characteristics and frequency

documentation Criteria

  • Detailed symptom description and treatment response

Applicable To

  • Episodic migraine without aura

Excludes

  • Chronic migraine without aura (G43.709)

Clinical Validation Requirements

  • ≥5 attacks
  • Headache lasting 4-72 hours
  • Unilateral, pulsating pain
  • Nausea or photophobia

Code-Specific Risks

  • Incorrectly coding as intractable without documentation of treatment failure.

Coding Notes

  • Ensure documentation specifies frequency and duration to differentiate between episodic and chronic migraines.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Headache, unspecified

R51.9
Use when headache characteristics do not meet migraine criteria.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Chronic migraine without aura

G43.709
Use when there are ≥15 headache days/month for over 3 months.

Migraine without aura, not intractable, without status migrainosus

G43.009
Use for episodic migraines with fewer than 15 headache days/month.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Migraine Without Aura to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G43.009.

Impact

Clinical: Incomplete clinical picture., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.

Mitigation Strategy

Use structured templates., Train staff on documentation standards.

Impact

Reimbursement: May affect DRG assignment and reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.

Mitigation Strategy

Verify headache frequency and duration over 3 months.

Impact

Incorrect coding of episodic migraines as chronic.

Mitigation Strategy

Regular audits and staff training on migraine documentation.

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 Without Aura, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Migraine Without Aura

Use these documentation templates to ensure complete and accurate documentation for Migraine Without Aura. These templates include all required elements for proper coding and billing.

Neurology Progress Note for Migraine

Specialty: Neurology

Required Elements

  • Headache characteristics
  • Frequency and duration
  • Associated symptoms
  • Treatment response

Example Documentation

Patient presents with unilateral, pulsating headaches lasting 6 hours, occurring 12 times per month, with nausea and photophobia. Responds to sumatriptan.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has migraines.
Good Documentation Example
Patient experiences unilateral, pulsating headaches lasting 6 hours, occurring 12 times per month, with nausea and photophobia. Responds to sumatriptan.
Explanation
The good example provides specific details on headache characteristics, frequency, and treatment response.

Need help with ICD-10 coding for Migraine Without Aura? Ask your questions below.

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