ICD-10 Coding for Chronic Migraine Headache(G43.709, G43.E11)
Complete ICD-10-CM coding and documentation guide for Chronic Migraine Headache. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chronic Migraine Headache
G43.7-G43.EPrimary Range
Chronic migraine codes, including with and without aura
These codes are used to classify chronic migraine headaches, distinguishing between those with and without aura.
Chronic tension-type headache codes
Used for differential diagnosis when chronic tension-type headache is suspected instead of migraine.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G43.709 | Chronic migraine without aura, not intractable | Use when chronic migraine is documented without aura and is not intractable. |
|
| G43.E11 | Chronic migraine with aura, intractable | Use when chronic migraine with aura is documented and is intractable. |
|
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 chronic migraine with aura
Essential facts and insights about Chronic Migraine Headache
Primary ICD-10-CM Codes for chronic migraine headache
Decision Criteria
clinical Criteria
- Patient reports ≥15 headache days/month without aura symptoms.
Applicable To
- Chronic migraine without aura
Excludes
- Chronic migraine with aura (G43.E-)
Clinical Validation Requirements
- Headaches occurring ≥15 days/month for ≥3 consecutive months
- No aura symptoms documented
Code-Specific Risks
- Undercoding if aura is present but not documented
Coding Notes
- Ensure documentation specifies the absence of aura to use this code.
G43.E11 - Chronic migraine with aura, intractable
Use when chronic migraine with aura is documented and is intractable.
Applicable To
- Chronic migraine with aura
Excludes
- Chronic migraine without aura (G43.7-)
Clinical Validation Requirements
- Headaches occurring ≥15 days/month for ≥3 consecutive months
- Documented aura symptoms
- Intractable to at least two prophylactic treatments
Coding Notes
Ensure documentation includes aura symptoms and treatment resistance.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term use of migraine prophylaxis
Z79.83Differential 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 Chronic Migraine Headache to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G43.709.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Ensure thorough patient interviews, Review patient history for aura documentation
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Ensure documentation specifies aura presence and intractability to use specific codes.
Impact
Inadequate documentation may lead to audit findings.
Mitigation Strategy
Use standardized headache diaries and templates.
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 Chronic Migraine Headache, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chronic Migraine Headache
Use these documentation templates to ensure complete and accurate documentation for Chronic Migraine Headache. These templates include all required elements for proper coding and billing.
Chronic migraine with aura
Specialty: NeurologyRequired Elements
- Headache frequency and duration
- Aura symptoms
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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