ICD-10 Coding for Complex Regional Pain Syndrome(G90.5, G56.4)
Complete ICD-10-CM coding and documentation guide for Complex Regional Pain Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Complex Regional Pain Syndrome
G90.5Primary Range
Complex Regional Pain Syndrome I
Primary code range for CRPS I, used when there is no documented nerve injury.
Causalgia of upper and lower limbs
Used for CRPS II when there is a documented peripheral nerve injury.
Chronic pain, not elsewhere classified
Used as an ancillary code for chronic pain management related to CRPS.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G90.5 | Complex Regional Pain Syndrome I | Use when CRPS I is diagnosed without nerve injury. |
|
| G56.4 | Causalgia of upper limb | Use when CRPS II is diagnosed with nerve injury in the upper limb. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for complex regional pain syndrome
Essential facts and insights about Complex Regional Pain Syndrome
Primary ICD-10-CM Codes for complex regional pain syndrome
Decision Criteria
clinical Criteria
- Pain disproportionate to injury with symptoms in 3/4 Budapest categories.
coding Criteria
- No documented nerve injury.
Clinical Validation Requirements
- Pain disproportionate to injury
- Symptoms in at least 3 of 4 Budapest categories
Code-Specific Risks
- Incorrectly coding as CRPS II if nerve injury is not documented.
Coding Notes
- Ensure documentation specifies absence of nerve injury for CRPS I.
G56.4 - Causalgia of upper limb
Use when CRPS II is diagnosed with nerve injury in the upper limb.
Excludes
- CRPS I (G90.5)
Clinical Validation Requirements
- Documented peripheral nerve injury
Coding Notes
Ensure nerve injury is documented for CRPS II.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pain due to trauma
G89.21Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Complex Regional Pain Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G90.5.
Impact
Clinical: Inadequate information for treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Use detailed templates for pain assessment., Train staff on documentation standards.
Impact
Reimbursement: Potential denial of claims due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify documentation for nerve injury before coding CRPS II.
Impact
High risk of audit if CRPS is coded without meeting Budapest Criteria.
Mitigation Strategy
Ensure all clinical criteria are documented before coding.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Complex Regional Pain Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Complex Regional Pain Syndrome
Use these documentation templates to ensure complete and accurate documentation for Complex Regional Pain Syndrome. These templates include all required elements for proper coding and billing.
CRPS I Diagnosis and Management
Specialty: NeurologyRequired Elements
- Detailed pain description
- Budapest Criteria assessment
- Temperature asymmetry documentation
- Exclusion of nerve injury
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Complex Regional Pain Syndrome? Ask your questions below.