2025 ICD-10-CM code G44.00
(Active) Effective Date: N/A Diseases of the nervous system - G40-G47 6 Feed
Cluster headache syndrome, unspecified.
Medical necessity for treatment of cluster headaches is established by the debilitating nature of the pain and associated symptoms that significantly impact the patient's quality of life. The intensity and frequency of the headaches justify the need for medical intervention, including acute and preventive treatments.
Diagnosis of cluster headache syndrome is based on clinical presentation, including patient history, physical and neurological examination. Imaging (MRI, CT), EEG, and ophthalmological assessments may be used to rule out other conditions. Treatment may include medications like triptans, lidocaine, dihydroergotamine, oxygen therapy, corticosteroids, and verapamil.
In simple words: This code refers to a type of severe headache called cluster headache, where the headaches come in groups or clusters.These headaches cause intense pain, usually around one eye, and can be accompanied by other symptoms such as watery eyes, redness, or a drooping eyelid on the same side as the pain.This specific code is used when the doctor hasn't specified whether the cluster headaches are episodic or chronic, or how difficult they are to treat.
Cluster headache syndrome is characterized by severe headaches that occur in groups (clusters) lasting for days, weeks, or months, followed by remission periods. This code specifies that the type of cluster headache (episodic or chronic) and its intractability are not documented.
Example 1: A 35-year-old male presents with severe, unilateral orbital pain lasting 45 minutes, accompanied by tearing and a drooping eyelid. The headaches have occurred several times a day for the past two weeks, followed by periods of no headaches. The physician diagnoses cluster headache syndrome, but does not specify if it is episodic or chronic., A 28-year-old female experiences sudden onset of sharp, burning pain around her left eye, lasting about an hour. She also reports a runny nose and eyelid swelling on the same side. These episodes have been occurring daily for a month. The diagnosis is cluster headache syndrome, unspecified., A patient with a history of "cluster headaches" presents with a current episode. The documentation lacks details on whether the headaches are episodic or chronic. G44.00 is used due to the lack of specific information.
Documentation should include the frequency, duration, and severity of headaches, associated symptoms (e.g., lacrimation, ptosis, rhinorrhea), and any triggers or relieving factors. Information about remission periods should also be noted if applicable.If the provider has determined the cluster headaches to be episodic or chronic, that should be documented, as well as whether or not the headaches are intractable.Diagnostic testing results, if performed, should also be included in the documentation.
** Cluster headaches are sometimes referred to by other names, such as histamine headache, Horton's headache, migrainous neuralgia, ciliary neuralgia, and others.It's important to distinguish cluster headaches from other headache disorders, such as migraine or sinusitis.If documentation is unclear, querying the provider for clarification is necessary for accurate coding.
- Specialties:Neurology, Pain Management, Ophthalmology
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital, Emergency Room - Hospital, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home