G43.A1
BillableCyclical vomiting, in migraine, intractable
HCC Category Mapping
RxHCCHCC 166 — Migraine
0.000What This Code Means
Repeated episodes of severe vomiting associated with migraines that do not respond well to treatment.
Coding Tips
- •Document that the cyclical vomiting is intractable and resistant to standard migraine and antiemetic therapies
- •Ensure the vomiting is directly related to the migraine condition
Clinical Significance
Cyclical vomiting syndrome in the context of migraine is an episodic condition characterized by recurrent, stereotypical episodes of intense nausea and vomiting, often with headache and migraine features. This condition is recognized as a migraine variant and is distinct from other causes of cyclical vomiting such as metabolic disorders or cannabinoid hyperemesis syndrome. Accurate coding captures the migraine relationship which guides treatment with migraine-specific prophylaxis and abortive therapies.
Documentation Requirements
- ✓Recurrent episodes of intense vomiting following a stereotypical pattern
- ✓Provider documentation linking cyclical vomiting to migraine pathophysiology
- ✓Episode frequency, duration, and symptom-free interval documentation
- ✓Exclusion of metabolic, gastrointestinal, or other causes of cyclical vomiting
- ✓Associated migraine features (headache, photophobia, phonophobia) if present
- ✓Intractability status: failed preventive and abortive treatments
- ✓Emergency department utilization pattern if applicable
Commonly Confused Codes
R11.10 (Vomiting, unspecified) — nonspecific; use G43.A when cyclical pattern linked to migraine is establishedR11.15 (Cyclical vomiting syndrome, unrelated to migraine) — use when cyclical vomiting has no migraine associationG43.909 (Migraine, unspecified, without status migrainosus) — does not capture the cyclical vomiting variantK31.89 (Other diseases of stomach and duodenum) — GI causes should be excluded before coding migraine-related CVSF50.89 (Other specified eating disorder) — psychogenic vomiting is a different entity
Code Hierarchy
└G43Migraine└G43.ACyclical vomiting└G43.A1Cyclical vomiting, in migraine, intractable
└G43.A1Cyclical vomiting, in migraine, intractable