ICD-10 Coding for Migraine with Aura(G43.109, G43.E11)
Complete ICD-10-CM coding and documentation guide for Migraine with Aura. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Migraine with Aura
G43.1-G43.9Primary Range
Migraine
This range includes all types of migraines, with G43.1 specifically for migraine with aura.
Chronic Migraine
This range includes chronic migraine codes, which are relevant for migraines with aura that meet chronic criteria.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G43.109 | Migraine with aura, not intractable, without status migrainosus | Use when documenting a migraine with aura that is not chronic, not intractable, and without status migrainosus. |
|
| G43.E11 | Chronic migraine with aura, intractable, with status migrainosus | Use when chronic migraine with aura is documented as intractable and with status migrainosus. |
|
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 with aura
Essential facts and insights about Migraine with Aura
Primary ICD-10-CM Codes for migraine with aura
Decision Criteria
clinical Criteria
- Presence of aura symptoms preceding headache
Applicable To
- Migraine with aura without prolonged aura
Excludes
- Hemiplegic migraine (G43.4)
Clinical Validation Requirements
- Aura symptoms such as visual disturbances or sensory changes
- Headache following aura
Code-Specific Risks
- Misclassification if chronic criteria are met but not documented
Coding Notes
- Ensure documentation specifies aura characteristics and headache details.
G43.E11 - Chronic migraine with aura, intractable, with status migrainosus
Use when chronic migraine with aura is documented as intractable and with status migrainosus.
Applicable To
- Chronic migraine with aura lasting over 72 hours
Excludes
- Migraine without aura (G43.0)
Clinical Validation Requirements
- Documentation of ≥15 headache days per month for ≥3 months
- Failed treatment attempts with at least two preventive medications
Coding Notes
Ensure chronicity and intractability are clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Migraine with Aura to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G43.109.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Use specific ICD-10 terminology, Include detailed patient history
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate data on chronic migraine prevalence.
Mitigation Strategy
Use G43.E- with frequency documentation
Impact
Reimbursement: Potential underpayment for complex cases., Compliance: Failure to meet coding specificity requirements., Data Quality: Inaccurate representation of treatment-resistant cases.
Mitigation Strategy
Query: 'Please specify medications tried'
Impact
Failure to document headache frequency leading to incorrect coding.
Mitigation Strategy
Use headache diaries and detailed patient histories.
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 Aura, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Migraine with Aura
Use these documentation templates to ensure complete and accurate documentation for Migraine with Aura. These templates include all required elements for proper coding and billing.
Chronic Migraine with Aura
Specialty: NeurologyRequired Elements
- Headache frequency
- Aura description
- Intractability markers
- Status migrainosus presence
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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