ICD-10 Coding for Ocular Migraine(G43.1-, G43.81, G43.E-)
Complete ICD-10-CM coding and documentation guide for Ocular Migraine. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ocular Migraine
G43.1-Primary Range
Migraine with aura
Primary range for migraines with visual disturbances, including ocular migraines.
Chronic migraine with aura
Used for chronic migraines with aura, including ocular migraines with chronicity.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G43.1- | Migraine with aura | Use when patient experiences visual disturbances preceding a headache. |
|
| G43.81 | Retinal migraine | Use for monocular visual disturbances without headache. |
|
| G43.E- | Chronic migraine with aura | Use for chronic migraines with frequent visual aura. |
|
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 ocular migraine
Essential facts and insights about Ocular Migraine
Primary ICD-10-CM Codes for ocular migraine
Decision Criteria
clinical Criteria
- Presence of visual aura preceding headache
Applicable To
- Scintillating scotoma
- Visual aura
Excludes
- Migraine without aura
- Retinal migraine
Clinical Validation Requirements
- Documented visual aura lasting 5-60 minutes
- Headache follows aura
Code-Specific Risks
- Risk of using unspecified codes when more specific ones are available.
Coding Notes
- Ensure documentation specifies aura characteristics and duration.
G43.81 - Retinal migraine
Use for monocular visual disturbances without headache.
Applicable To
- Monocular visual disturbances
Excludes
- Bilateral visual aura
Clinical Validation Requirements
- Monocular visual symptoms confirmed by ophthalmologic exam
Coding Notes
Document laterality and confirm monocular symptoms.
G43.E- - Chronic migraine with aura
Use for chronic migraines with frequent visual aura.
Applicable To
- Chronic migraines with visual aura
Excludes
- Episodic migraines
Clinical Validation Requirements
- ≥15 headache days/month for 3+ months
- Aura present on ≥8 days/month
Coding Notes
Document frequency and chronicity of headaches and aura.
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 Ocular Migraine to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G43.1-.
Impact
Clinical: May lead to incorrect diagnosis., Regulatory: Increases risk of audit issues., Financial: Potential for denied claims.
Mitigation Strategy
Always document which eye is affected., Confirm monocular symptoms with testing.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of healthcare data.
Mitigation Strategy
Ensure documentation supports the most specific code available.
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Ensure documentation supports the most specific code.
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 Ocular Migraine, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ocular Migraine
Use these documentation templates to ensure complete and accurate documentation for Ocular Migraine. These templates include all required elements for proper coding and billing.
Ocular migraine with aura
Specialty: NeurologyRequired Elements
- Visual symptoms
- Duration
- Frequency
- Treatment response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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