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Coding Migraine in ICD-10-CM

Neurology billing, primary care billing, and emergency room billing are about to become a bit more complicated when patients present with a migraine. Coding Migraine in ICD-10-CM presents a number of challenges to medical coders and billers. The new methodology will require even greater specificity when it comes to assigning codes to healthcare claims, and will have to be supported by the available documentation. When a patient presents with a migraine that needs to be translated into ICD-10 diagnosis code, a total of six characters are needed to reach the greatest degree of specificity in order to create a clean healthcare claim. Migraines fall under the G40-G47 subset of ICD-10-CM codes, Episodic and paroxysmal disorders. By understanding the underlying logic of how ICD-10 is arranged, it is expected that less time will be spent cross-referencing the alphabetic and numeric indices.

Migraine is a neurological disease characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms. Typically the headache affects one half of the head, associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell.

Types of Migraine are as follows:

  • Migraine without aura or common migraine.
  • Migraine with aura or classic migraine.
  •  Two other varieties are familial hemiplegic migraine and sporadic hemiplegic migraine. Another variety is basilar-type migraine and  retinal migraine.
  • Probable migraine describes conditions that have some characteristics of migraines, but where there is not enough evidence to diagnose it as a migraine with certainty (in the presence of concurrent medication overuse).
  • Chronic migraine .

Under ICD-10 methodology, diseases of the nervous system are described by the codes contained between G00 and G99.

When a patient presents with a migraine , a total of six characters are needed to reach the greatest degree of specificity. Migraines fall under the G40-G47 subset of ICD-10-CM codes, Episodic and paroxysmal disorders. By understanding the underlying logic of how ICD-10 is arranged, it is expected that less time will be spent cross-referencing the alphabetic and numeric indices.

There are 44 codes dedicated to ICD-10, describing various types of migraines like:

  • G43 is used to indicate that the patient was treated for migraine, but this code requires three additional characters to report payable diagnostic information. Each additional character builds on the placeholder before it until the sequence of information provides a complete picture of the patient’s medical condition.
  • 0 is a migraine without aura. Adding a 1 to this code indicates an intractable migraine without aura. Intractable means the migraine does not get better with standard treatment.

In the ICD-10-CM, under the Migraine (G43), there are terms mentioned which are equivalent to intractable .They are as follows:

  • Pharmacoresistant (pharmacologically resistant),
  • Treatment resistant,
  • Refractory (medically) and
  • Poorly controlled.

Any of these terms used  in the documentation can be coded as intractable migraine.

Conclusion: It is most likely to happen  after the transition to ICD-10, a coder or medical auditor will review the available documentation in the patient’s medical record in an even more systematic manner in order to come up with the most accurate codes.

Migraine ICD-10