Q&A: Accurately capturing migraines and their variations

Q: What terms need to be included in physician documentation to code in ICD-10-CM whether the patient’s migraine is chronic, intractable, or with status migrainosus?

A: “The patient has a migraine,” is insufficient documentation. Let’s talk about the key terms you need to clarify from the documentation how exactly to report migraines out of the 50 possible migraine ICD-10-CM codes.

To classify as a “chronic” migraine, the physician’s documentation must identify that this patient has been having 15 or more episodes per month for the last three months, according to the American Migraine Foundation.

You don’t necessarily need the number “15,” and you don’t necessarily need the number “three,” but you need an indication of that as a minimum. It may be more. And, if it is more, it will just underscore the fact that this is a chronic condition.

So, in talking with your physicians about the documentation, I would make sure they are documenting if there are at least 15 or more episodes a month for three or more consecutive months, instead of just relying on the word “chronic,” as the safety net.

If the physician diagnoses a patient as having chronic migraines, then it’s legal for us to report that, but, remember that we want not only continuity of care, we also want it to be able to withstand an audit. Therefore, these details are important to be somewhere in the documentation to correspond with the most appropriate ICD-10-CM code.

The ICD-10-CM migraine codes that were established October 1, 2023 include:

• G43.E01, chronic migraine with aura, not intractable, with status migrainosus
• G43.E09, chronic migraine with aura, not intractable, without status migrainosus
• G43.E11, chronic migraine with aura, intractable, with status migrainosus
• G43.E19, chronic migraine with aura, intractable, without status migrainosus

Intractable means that the migraine cannot be stopped, even with medication. If this is the case, there needs to be documentation beyond “the patient is having an intractable chronic migraine.” Coders will need to have documentation of what medication or treatment methods were tried and for how long and the fact that they did not work.

That’s the other part of it and that’s very important for the reimbursement because auditors may ask “Well, you say it’s intractable and couldn’t be stopped by medication, but what medication did you try and how long did you try it? How do we know?”

For status migrainosus, the headache is not responding to treatment and has lasted longer than 72 continuous hours. Again, the attempts to treat the patient must be documented specifically. So, this is the key: you need to make sure the physician is documenting specific treatments that did not work.

If the patient’s condition is not intractable or not status migrainosus, coders don’t need to worry about documentation. They don’t need to document the absence of any parts of a diagnosis.

Editor’s note: This Q&A was originally published in JustCoding. Shelley C. Safian, PhD, RHIA, HCISPP, CCS-P, AHIMA-approved ICD-10-CM/PCS trainer in Longwood, Florida, answered this question during the HCPro webinar, “Chronic Migraines in ICD-10-CM: Coding Without the Headache.”