Cyclical vomiting, in migraine, intractable

This code signifies a specific type of migraine characterized by recurrent, severe episodes of nausea and vomiting, occurring in a cyclical pattern, that is resistant to standard medical treatment. The vomiting episodes are typically stereotypic in onset, duration, and associated symptoms, and are not attributable to other gastrointestinal or neurological conditions. The "intractable" designation indicates that the condition is difficult to manage or cure with conventional therapies.

Use this code when documentation clearly states a diagnosis of cyclical vomiting that is directly associated with migraine and is noted as intractable or refractory to treatment. This typically applies to patients experiencing severe, debilitating, and recurring emetic episodes that have not responded adequately to multiple lines of therapy. Supporting documentation should include a history of migraine, cyclical vomiting patterns, and failed treatment attempts.

• Ensure documentation explicitly links the cyclical vomiting to migraine and specifies its intractable nature.
• Do not confuse this with cyclical vomiting syndrome (R11.13) unless it is clearly stated as a manifestation of migraine.
• Consider sequencing this code as the primary diagnosis if the intractable cyclical vomiting is the main reason for the encounter.