G43.B0
BillableOphthalmoplegic migraine, not intractable
HCC Category Mapping
RxHCCHCC 166 — Migraine
0.000What This Code Means
A rare type of migraine that causes temporary paralysis of the eye muscles, which can be managed with treatment.
Coding Tips
- •Ophthalmoplegic migraine is rare; ensure proper neurological documentation and imaging support the diagnosis
- •This condition may require differentiation from other causes of ophthalmoplegia through diagnostic testing
Clinical Significance
Ophthalmoplegic migraine (now reclassified as recurrent painful ophthalmoplegic neuropathy) involves recurrent episodes of headache accompanied by paresis of one or more ocular cranial nerves (III, IV, or VI). This rare condition requires thorough neurological workup to exclude aneurysm, tumor, or other compressive lesions, making accurate coding important for justifying diagnostic imaging. The distinction between intractable and not intractable reflects treatment responsiveness and impacts medication management decisions.
Documentation Requirements
- ✓Documented ocular cranial nerve palsy (III, IV, or VI nerve involvement specified)
- ✓Temporal association between headache and onset of ophthalmoplegia
- ✓Recurrent episode pattern (not first-time presentation, which requires urgent workup for other causes)
- ✓Neuroimaging results (MRI with gadolinium) excluding structural lesion, aneurysm, or tumor
- ✓Resolution of ophthalmoplegia between episodes (though residual deficit may persist)
- ✓Treatment response noted
- ✓Ophthalmologic examination documenting specific eye movement deficits
Commonly Confused Codes
H49.00-H49.89 (Paralytic strabismus/cranial nerve palsies) — use for isolated cranial nerve palsy without migraine contextG43.401-G43.419 (Hemiplegic migraine) — involves body hemiparesis, not ocular nerve palsyG43.801-G43.819 (Other migraine) — ophthalmoplegic migraine has its own specific code; do not use 'other'I67.1 (Cerebral aneurysm, nonruptured) — must be excluded as cause of third nerve palsy before coding ophthalmoplegic migraineH46.x (Optic neuritis) — inflammation of optic nerve, not ocular motor nerve palsy
Code Hierarchy
└G43Migraine└G43.BOphthalmoplegic migraine└G43.B0Ophthalmoplegic migraine, not intractable
└G43.B0Ophthalmoplegic migraine, not intractable