G43.619
BillablePersistent migraine aura with cerebral infarction, intractable, without status migrainosus
HCC Category Mapping
RxHCCHCC 166 — Migraine
0.000What This Code Means
A serious type of migraine with visual disturbances causing stroke-like symptoms that is difficult to treat and does not respond well to standard migraine medications.
Coding Tips
- •This code requires documentation of failed treatment attempts with multiple migraine medications to establish 'intractable' status.
- •The '19' suffix indicates intractable without status migrainosus; document why standard treatments have been ineffective.
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
- ✓Episode duration noted
- ✓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 infarctedI63.x (Cerebral infarction) — standalone stroke codes; use G43.6xx when infarction occurs in the context of migraine auraG43.401-G43.419 (Hemiplegic migraine) — motor weakness from migraine without actual infarctionI67.89 (Other cerebrovascular disease) — non-specific vascular conditions without migraine contextG45.x (Transient cerebral ischemic attacks) — reversible ischemia without confirmed infarction
Code Hierarchy
└G43Migraine└G43.6Persistent migraine aura with cerebral infarction└G43.61Persistent migraine aura with cerebral infarction, intractable└G43.619Persistent migraine aura with cerebral infarction, intractable, without status migrainosus
└G43.619Persistent migraine aura with cerebral infarction, intractable, without status migrainosus