ICD-10 Code for History of Migraines
The appropriate ICD-10-CM code for a personal history of migraine is Z86.59 (Personal history of other mental and behavioral disorders), though this is imperfect as there is no specific "history of migraine" code in ICD-10-CM.
Understanding the Coding Challenge
The ICD-10-CM system does not have a dedicated code specifically for "personal history of migraine." This creates a documentation gap that medical coders and clinicians must navigate carefully.
Coding Options and Rationale
Current Active Migraine
If the patient currently has migraine (even if not actively experiencing an attack), use the appropriate G43.xxx codes:
- G43.909 - Migraine, unspecified, not intractable, without status migrainosus (most commonly used when specific type unknown)
- G43.109 - Migraine without aura, not intractable, without status migrainosus
- G43.109 - Migraine with aura, not intractable, without status migrainosus
- G43.709 - Chronic migraine without aura, not intractable, without status migrainosus
The clinical guidelines emphasize that migraine diagnosis follows ICHD-3 criteria, requiring at least 5 attacks for migraine without aura or 2 attacks for migraine with aura 1. If the patient has met these criteria at any point and the condition remains relevant to their care, code it as active migraine rather than "history of."
True Resolved History
If the migraine condition is truly resolved and no longer clinically relevant:
- Z86.59 - Personal history of other mental and behavioral disorders (suboptimal but most commonly used)
- Some coders use Z87.898 - Personal history of other specified conditions (also imperfect)
Common Pitfalls
Critical caveat: Research shows that only 37-58% of patients with ICD-9-CM headache diagnoses received corresponding ICD-10-CM codes in subsequent years 2. This suggests significant under-coding of headache conditions. Do not assume migraine has "resolved" simply because it's not currently being treated—migraine is typically a chronic, episodic condition that waxes and wanes 1.
When to Code as Active vs. History
- Code as active (G43.xxx) if: Patient has had qualifying attacks in the past, condition affects current treatment decisions, patient takes preventive medications, or condition may recur
- Code as history (Z86.59) only if: Condition occurred years ago, patient has been completely symptom-free for extended period, and it has no bearing on current care
Documentation Best Practices
Given the coding challenges identified in research 2, 3, ensure documentation includes:
- Specific migraine type (with/without aura, chronic vs. episodic)
- Frequency and last occurrence of attacks
- Whether condition is active, controlled, or truly resolved
- Current treatment status (acute medications, preventives, or none)
The strong association between ICD-9-CM and ICD-10-CM coding (OR 6-26 for same diagnosis) demonstrates that clear initial documentation significantly improves coding accuracy 2.