G43.B1

HCC Category Mapping

What This Code Means

A severe type of migraine that causes temporary paralysis of the eye muscles, making it difficult or impossible to move the eyes, and does not respond well to treatment.

Coding Tips

• •Verify documentation confirms both ophthalmoplegic features and intractability (resistant to treatment)
• •This is a rare migraine variant; ensure proper differentiation from other neurological conditions causing eye movement problems

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)
• ✓Intractability status documented
• ✓Ophthalmologic examination documenting specific eye movement deficits

Commonly Confused Codes