ICD Code G43.109

ICD code G43.109 is a classification used to identify a type of migraine characterized by the presence of an aura, which is a set of sensory disturbances that occur before the headache phase. This specific code indicates that the migraine is not intractable, meaning it can be managed or relieved with treatment, and it does not involve status migrainosus, a severe and prolonged migraine attack lasting more than 72 hours. This code is utilized in healthcare settings for accurate documentation, billing, and treatment planning.

1. Presence of Aura: The patient experiences an aura, which typically includes visual disturbances such as flashing lights, zigzag patterns, or blind spots. Other aura symptoms may involve sensory, speech, or language disturbances.

2. Headache Characteristics: The headache is typically unilateral, pulsating, and of moderate to severe intensity. It may be aggravated by routine physical activity.

3. Duration: The headache phase lasts between 4 to 72 hours if untreated or unsuccessfully treated.

4. Associated Symptoms: During the headache, the patient may experience nausea and/or vomiting, as well as photophobia (sensitivity to light) and phonophobia (sensitivity to sound).

5. Not Intractable: The migraine is responsive to standard treatment options, meaning it can be managed or alleviated with appropriate medication or interventions.

6. Absence of Status Migrainosus: The migraine does not persist for more than 72 hours, excluding any periods of relief that last less than 12 hours.

7. Frequency and Pattern: The patient has a history of recurrent headaches that fit the above criteria, typically occurring episodically rather than chronically.

These criteria should be thoroughly evaluated by healthcare providers to ensure accurate diagnosis and appropriate use of the ICD code.

For the ICD code G43.109, which pertains to migraine with aura, not intractable, without status migrainosus, the relevant CPT codes that may be applicable for treatment include:

1. 99201-99215: Evaluation and Management (E/M) services, which cover office or other outpatient visits for the evaluation and management of a patient.

2. 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.

3. J3030: Injection, sumatriptan, 6 mg (used for acute treatment of migraine attacks).

4. J1885: Injection, ketorolac tromethamine, per 15 mg (often used for pain management in migraine treatment).

5. J1100: Injection, dexamethasone sodium phosphate, 1 mg (used for anti-inflammatory purposes in migraine treatment).

6. J3490: Unclassified drugs (used when a specific drug does not have a designated code).

These CPT codes are commonly used in the treatment and management of migraines and may be relevant depending on the specific treatment plan and services provided. Always ensure that the chosen CPT codes accurately reflect the services rendered and are supported by the patient's medical documentation.

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