G43

G43: Migraine

Non-billable headerICD-10-CM

G43 is a non-billable header ICD-10-CM code for migraine. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

The excluded condition is not part of this code, but a patient can have both. You may code both.

Add a secondary code to capture the detail described below.

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Additional guidance from the ICD-10-CM tabular list.

the following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled

Their own Excludes1 notes name this code, so the conflict is not listed above.

No CMS-HCC V28 category: this code does not change a RAF score.

Unchanged in every release from FY2024 to FY2027.

13 child codes. Green means billable.