We all experience headache sometimes when not having enough sleep, more stress, along with any disease or due to unknown cause. The type of headache can vary based on location, severity, frequency and cause. Headache is mainly divided into 4 types – migraine, tension type, hypnic and cluster. We will discuss here about the basic details of ICD 10 Code for migraine and guidelines along with examples.
Migraine is very common and can affect children or adults. It is characterized by throbbing pain usually one side of the head associated with nausea and/or vomiting and sensitivity to light. Sometimes severity of the pain can be very severe and can last for more than 2 days.
Migraine occurs in 4 stages (though not all stages in everyone) – Prodrome, aura, attack, post-drome. Knowing the stages is important in assigning a case specific ICD code.
- Prodrome – This is a stage prior to migraine which shows few symptoms as warning sign of getting migraine. These symptoms may include fatigue, severe thirst, mood changes, constipation, neck stiffness and frequent yawning.
- Aura – These symptoms occur just before or during migraine. Symptoms include, black dots, flashes of light, hallucination, unable to speak clearly, weakness or numbness on face or one side of the body, difficulty in talking.
- Attack – These are symptoms occurring during migraine. The type of pain can be throbbing at one side of the head associated with light sensitivity and nausea, vomiting.
- Post-drome – Symptoms after migraine includes tiredness, weakness, muscle pain, feels refreshed or cranky.
Tests and Diagnosis:
Physician can diagnose migraine based on history, signs and symptoms. An MRI or CT of brain is done if feels any complications or difficulty to diagnose.
ICD 10 Code for Migraine and guidelines:
ICD 10 Code for migraine is found in chapter 6 of ICD-10 CM manual – diseases of nervous system, code range G00 – G99
- Coder should not decide the migraine is with or without aura as per the signs and symptoms documented in the chart. It should be diagnosed by the physician.
- It is very important to look for the words “aura”, intractable” and “status migrainous” in the medical record to assign the correct code.
- Chronic migraine does not have a direct entry in ICD-10 manual index. It should be coded as G43.709 (migraine, without aura, chronic)
- Category G46 (migraine with cerebral infarction) needs an additional code from category I63 (cerebral infarction) to specify the type of cerebral infarction.
- Common migraine should be coded as migraine without aura
- Classical or basilar migraine should be coded as migraine with aura.
- Migraine, idiopathic should be coded as unspecified migraine G43.909
|ICD 10 Code for Migraine
|G43.001 – G3.019
|Migraine; without aura
|G43.101 – G3.119
|; with aura
|G43.401 – G3.419
|G43.501 – G3.519
|Persistent with aura without cerebral infarction
|G43.601 – G3.619
|Persistent with aura with cerebral infarction
|G43.701 – G3.719
|Chronic without aura
|G43.801 – G3.839
|G43.901 – G3.919
|G43.B0 – G3.B1
|G43.D0 – G3.D1
Below are few examples on coding Migraine.
ICD 10 Code for Migraine Example 1:
Sarah, is a 30 year old woman visits the clinic for frequent headache from past 5 months. She is a computer expert and uses computer 12 to 14 hours a day. She feels vision problem and black dots on the screen just before the headache starts. The pain is throbbing at one side of the head. She takes triptan for relief and the pain goes away after few hours. She gets this problem continuously for 4 days. She started taking contraceptive pill from last 2 months. Her headache is worse when taking the pill and gets numbness on hands. Her vitals are normal today. Physical exam findings noted as healthy woman, alert and oriented with bilateral hand swelling. A complete neurological exam was performed which was normal. An MRI of brain was taken today to rule out any abnormalities. This case was diagnosed as migraine with aura.
G43.109 – Migraine with aura
M79.89 – Hand swelling
Note: Coder should assign “with aura” only if physician diagnosed the same.
ICD 10 Code for Migraine Example 2:
A 55 year old male patient came to hospital with a known history of chronic migraine. He gets headache almost every day though he uses medication. He has a history of hypertension and CAD (NSTEMI last year). His medication list includes brilinta, plavix, nitoglycerin, lisinopril and triptan. BP reading showed 135/95 mmHg today. All other vitals are normal. Neurologic exam was normal. Physician suggested starting on onabotulinumtoxinA injection after discussing the case with neurologist. The patient was given referral to neurologist.
G43.709 – Chronic migraine
I10 – Hypertension
I25.10 – CAD
I25.2 – Old MI
Note: Coded G43.709 (chronic migraine without aura) though not mentioned as with or without aura as there is no specific index entry for migraine chronic directly.