ICD-10 Coding for Migraine(G43.E0, G43.E1)
Complete ICD-10-CM coding and documentation guide for Migraine. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to 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.E0 | Chronic migraine without aura, not intractable | Use when the patient has chronic migraine without aura and is not intractable. |
|
| G43.E1 | Chronic migraine with aura, not intractable | Use when the patient has chronic migraine with aura and is not 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 Migraine
Primary ICD-10-CM Codes for migrain
Decision Criteria
clinical Criteria
- 15+ migraine days per month for 3 months
documentation Criteria
- No aura symptoms documented
Applicable To
- Chronic migraine without aura
Excludes
- Tension-type headache (G44.2)
Clinical Validation Requirements
- 15+ migraine days per month for 3 months
- No aura symptoms
Code-Specific Risks
- Misclassification if aura symptoms are present
Coding Notes
- Ensure documentation specifies the absence of aura and intractability.
G43.E1 - Chronic migraine with aura, not intractable
Use when the patient has chronic migraine with aura and is not intractable.
Applicable To
- Chronic migraine with aura
Excludes
- Tension-type headache (G44.2)
Clinical Validation Requirements
- 15+ migraine days per month for 3 months
- Aura symptoms present
Coding Notes
Ensure documentation specifies the presence of aura.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Headache
R51Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Migraine to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G43.E0.
Impact
Clinical: Inaccurate diagnosis, Regulatory: Non-compliance with coding guidelines, Financial: Potential reimbursement issues
Mitigation Strategy
Use structured templates, Educate providers on documentation requirements
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Non-compliance with specificity requirements, Data Quality: Decreased accuracy in clinical data
Mitigation Strategy
Query for specific type and characteristics of migraine
Impact
Risk of audits due to insufficient documentation of migraine frequency and aura
Mitigation Strategy
Use headache diaries and structured 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 Migraine, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Migraine
Use these documentation templates to ensure complete and accurate documentation for Migraine. These templates include all required elements for proper coding and billing.
Chronic migraine with aura
Specialty: NeurologyRequired Elements
- Headache frequency
- Aura symptoms
- Treatment history
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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