G43.821
BillableMenstrual migraine, not intractable, with status migrainosus
HCC Category Mapping
RxHCCHCC 166 — Migraine
0.000What This Code Means
Migraine headaches that occur around menstrual periods and can be managed with treatment, with prolonged migraine symptoms lasting 72 hours or more.
Coding Tips
- •Status migrainosus indicates a migraine lasting more than 72 hours; ensure clinical documentation supports this duration
- •Confirm the migraine is related to menstrual cycle and that it is not intractable (responsive to treatment) before assigning this code
Clinical Significance
Menstrual migraine is a hormonally triggered migraine subtype occurring in relation to the menstrual cycle, typically within 2 days before to 3 days after menstruation onset. This diagnosis is clinically important because it guides hormone-specific treatment strategies including estrogen supplementation, triptans timed to the menstrual cycle, and contraceptive management. Accurate coding captures the hormonal etiology which affects both treatment planning and pharmacy utilization predictions.
Documentation Requirements
- ✓Temporal relationship to menstrual cycle documented (onset within day -2 to day +3 of menses)
- ✓Pattern occurring in at least 2 out of 3 consecutive menstrual cycles
- ✓Migraine features present (unilateral, pulsating, moderate-severe intensity, nausea/photophobia)
- ✓Distinction between pure menstrual migraine (only perimenstrual) vs. menstrually related migraine (also occurs at other times)
- ✓Response to treatment documented (not intractable)
- ✓Status migrainosus with episode >72 hours if applicable
- ✓Headache diary correlating attacks with menstrual dates
- ✓Hormonal medication history (oral contraceptives, hormone replacement therapy)
Commonly Confused Codes
G43.001-G43.019 (Migraine without aura) — use when migraine is not specifically linked to menstrual cycle timingG43.101-G43.119 (Migraine with aura) — menstrual migraine typically presents without aura; if aura present, consider dual codingN94.3 (Premenstrual tension syndrome) — PMS is not migraine; these are distinct conditions though they may coexistG43.801-G43.819 (Other migraine) — menstrual migraine has its own specific codes; do not use 'other'G43.901-G43.919 (Migraine, unspecified) — avoid when menstrual pattern is documented
Code Hierarchy
└G43Migraine└G43.8Other migraine└G43.82Menstrual migraine, not intractable└G43.821Menstrual migraine, not intractable, with status migrainosus
└G43.821Menstrual migraine, not intractable, with status migrainosus