ICD 10 Coding Alert

Question: I read “migraine” in a patient’s encounter notes, and I’m trying to understand the difference between an intractable migraine versus a not intractable migraine. I guess I should query?

Oregon Subscriber

Answer: You should query the provider for more information, because there are several codes that may be appropriate for a migraine. You need to know whether the migraine was with or without aura and, as you mention, intractable or not intractable.

An intractable migraine, also known as a refractory migraine, is a persistent migraine that is difficult to treat or fails to respond to standard and/or aggressive treatment modalities. A migraine that is not intractable would respond more readily to treatment. If you see the terms pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically), and poorly controlled, then you can consider them consistent with “intractable.”

Here are some coding options, once you get the information you need to select an accurate diagnosis code:

• G43.0- (Migraine without aura)
• G43.00- (Migraine without aura, not intractable)
• G43.01- (Migraine without aura, intractable)
• G43.1- (Migraine with aura)
• G43.4- (Hemiplegic migraine)

Rachel Dorrell, MA, MS, CPC-A, CPPM