Cracking the Code

Coding Migraines

What is a migraine? A migraine is a headache that can cause severe pulsing or throbbing usually on one side of the head. It can be associated with nausea, vomiting, and extreme sensitivity to sound or light. Migraine headaches can last up to several hours, even days for some patients. Migraines can have warning signs. Some of these signs can include blurred vision, flashes of light, zigzag lines, or even temporary vision loss. Code selection for migraines is based on the type of migraine.

Key terms to keep in mind while coding migraines are status migrainosus and intractable. The 5th character identifies whether it is intractable or not intractable. Intractable means the migraine cannot be controlled with medication. The 6th character identifies with or without status migrainosus. Migrainosus means that the migraine has been ongoing for more than 72 hours.

Q: A 43-year-old female patient with an ophthalmoplegic migraine is not responding to medication and is admitted to the observation unit. What ICD-10-CM code is reported?
A: G43.B1 Rationale: When a migraine does not respond to medication it is considered intractable. We see in the ICD-10-CM Alphabetic Index, Migraine/ophthalmoplegic/intractable referring us to G43.B1. We then verify code selection in the Tabular List. The note under category code G43 Migraine confirms that pharmacoresistant is considered intractable.
Reference: FY 2022 ICD-10-CM Coding Book, Mayo Clinic
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