G43.011
BillableMigraine without aura, intractable, with status migrainosus
HCC Category Mapping
RxHCCHCC 166 — Migraine
0.000What This Code Means
Migraine without aura that does not respond adequately to standard migraine treatments, with the patient experiencing status migrainosus, which is a prolonged migraine lasting more than 72 hours.
Coding Tips
- •Document intractability and confirm status migrainosus (migraine duration exceeding 72 hours)
- •Status migrainosus may require hospitalization; ensure acute care documentation is included
Clinical Significance
Migraine without aura, intractable, with status migrainosus represents the most severe presentation of this migraine type — drug-resistant migraines that have progressed to a continuous state lasting over 72 hours. These patients often require hospitalization, IV medications, and may need nerve blocks or other interventional procedures. This combination indicates very high healthcare resource utilization.
Documentation Requirements
- ✓Confirmed migraine without aura diagnosis
- ✓Documentation of intractability (failed adequate trials of preventive and acute medications)
- ✓Status migrainosus documented with migraine duration exceeding 72 hours
- ✓List of medications tried and failed
- ✓Inpatient or emergency treatment provided
- ✓Assessment for medication overuse headache as contributing factor
Commonly Confused Codes
G43.001 — Migraine without aura with status migrainosus, NOT intractableG43.019 — Migraine without aura, intractable, WITHOUT status migrainosusG43.111 — Migraine WITH aura, intractable, with status migrainosus; has aura symptomsG43.901 — Unspecified migraine with status migrainosus; less specificG44.41 — Drug-induced headache; medication overuse may mimic intractable migraine
Code Hierarchy
└G43Migraine└G43.0Migraine without aura└G43.01Migraine without aura, intractable└G43.011Migraine without aura, intractable, with status migrainosus
└G43.011Migraine without aura, intractable, with status migrainosus