G43.001

HCC Category Mapping

What This Code Means

Migraine without aura is a common type of headache characterized by throbbing pain, often on one side of the head, sometimes with nausea or sensitivity to light. This code indicates the migraine is controlled with treatment and the patient is experiencing status migrainosus, which is a prolonged migraine lasting more than 72 hours.

Coding Tips

• •Status migrainosus is a serious complication; ensure documentation clearly indicates migraine duration exceeds 72 hours
• •Verify that migraine without aura is confirmed (no visual or sensory symptoms preceding the headache)

Clinical Significance

Migraine without aura with status migrainosus identifies a debilitating migraine lasting more than 72 hours continuously. Status migrainosus is a complication that often requires emergency department visits or hospitalization for intravenous hydration, antiemetics, and parenteral pain management. This condition significantly impacts patient functioning and healthcare resource utilization.

Documentation Requirements

• ✓Confirmed migraine without aura diagnosis (no visual or sensory prodrome)
• ✓Documentation that migraine has lasted continuously for more than 72 hours (status migrainosus)
• ✓Statement that migraines generally respond to treatment (not intractable)
• ✓Treatments attempted and failed during the prolonged episode
• ✓Associated symptoms (nausea, vomiting, photophobia, phonophobia)
• ✓Emergency or inpatient care provided

Commonly Confused Codes