G43.611 ICD-10-CM Code: Persistent migraine aura with cerebral infarction, intractable, with status migrainosus
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G43.611
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePersistent migraine aura with cerebral infarction, intractable, with status migrainosus
This is a severe, ongoing migraine headache with visual or sensory warning signs (aura) that has caused a stroke in the brain, and the migraine symptoms are not responding to treatment. The patient is experiencing continuous migraine activity lasting more than 72 hours.
Buddy Insight
Persistent migraine aura with cerebral infarction (migrainous infarction) is a serious neurological emergency where migraine aura symptoms are accompanied by confirmed ischemic brain infarction on neuroimaging.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 166
RAF 0.0
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Code Book Path
Inclusion Terms
Official- Persistent migraine aura with cerebral infarction, with refractory migraine
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G43.611 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G43.611 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G43.611 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G43.611 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G43.611 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G43.611 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is G43.611 an HCC code?
No. G43.611 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for G43.611
For G43.611to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed G43.611 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
G43.611 is the ICD-10-CM diagnosis code for persistent migraine aura with cerebral infarction, intractable, with status migrainosus. This is a severe, ongoing migraine headache with visual or sensory warning signs (aura) that has caused a stroke in the brain, and the migraine symptoms are not responding to treatment. The patient is experiencing continuous migraine activity lasting more than 72 hours. G43.611 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering episodic and paroxysmal disorders (g40-g47).
G43.611 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Maps to RxHCC 166 (Severe Head Injury) with a RAF weight of 0.000 in the prescription drug model. Does NOT independently map to CMS-HCC V28 or V24, but the required additional cerebral infarction code (I63.x) DOES map to major stroke HCCs. Ensure the accompanying I63.x code is captured for full risk adjustment impact. No direct hierarchies apply to the migraine code itself.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G43.611 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code requires documentation of both the persistent aura with infarction AND the intractable status with status migrainosus - ensure the clinical record supports all components before assigning
- •Verify that imaging studies (CT or MRI) confirm cerebral infarction and that the provider has documented the migraine as the underlying cause; this is a serious complication requiring careful documentation review
Clinical Significance
Persistent migraine aura with cerebral infarction (migrainous infarction) is a serious neurological emergency where migraine aura symptoms are accompanied by confirmed ischemic brain infarction on neuroimaging. This represents one of the most severe migraine complications and demands urgent stroke protocol evaluation and intervention. Accurate coding is essential for capturing disease severity and ensuring appropriate risk adjustment across multiple models.
Documentation Requirements
- ✓Neuroimaging (MRI with diffusion-weighted imaging preferred) confirming cerebral infarction
- ✓Documentation of migraine aura symptoms that persisted and coincided with the infarction
- ✓Temporal relationship establishing aura preceded or accompanied the infarction event
- ✓Exclusion of other causes of cerebral infarction (cardioembolism, large-vessel atherosclerosis)
- ✓Intractability status documented by provider
- ✓Status migrainosus with documented duration >72 hours
- ✓Additional code for the specific cerebral infarction territory (I63.x) should be reported
- ✓Neurological deficit assessment and residual symptoms
Commonly Confused Codes
- •G43.501-G43.519 (Persistent migraine aura WITHOUT cerebral infarction): no infarction on imaging; use when aura persists but brain is not infarcted
- •I63.x (Cerebral infarction): standalone stroke codes; use G43.6xx when infarction occurs in the context of migraine aura
- •G43.401-G43.419 (Hemiplegic migraine): motor weakness from migraine without actual infarction
- •I67.89 (Other cerebrovascular disease): non-specific vascular conditions without migraine context
- •G45.x (Transient cerebral ischemic attacks): reversible ischemia without confirmed infarction