ICD-10 Coding for Reflex Sympathetic Dystrophy(G90.50, G90.51, G90.52)
Complete ICD-10-CM coding and documentation guide for Reflex Sympathetic Dystrophy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Reflex Sympathetic Dystrophy
G90.5-Primary Range
Complex Regional Pain Syndrome Type 1
This range covers CRPS Type 1, which is synonymous with Reflex Sympathetic Dystrophy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G90.50 | Complex regional pain syndrome I, unspecified | Use when the location of CRPS Type 1 is unspecified. |
|
| G90.51 | Complex regional pain syndrome I of upper limb | Use for CRPS Type 1 affecting the upper limb. |
|
| G90.52 | Complex regional pain syndrome I of lower limb | Use for CRPS Type 1 affecting the lower 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 reflex sympathetic dystrophy
Essential facts and insights about Reflex Sympathetic Dystrophy
Primary ICD-10-CM Codes for reflex sympathetic dystrophy
Decision Criteria
clinical Criteria
- Pain disproportionate to inciting event with autonomic changes
Clinical Validation Requirements
- Persistent burning pain with allodynia
- No major nerve injury
- At least one sign such as edema or temperature asymmetry
Code-Specific Risks
- Risk of under-documentation if laterality is known but not coded.
Coding Notes
- Ensure documentation specifies the absence of major nerve injury.
G90.51 - Complex regional pain syndrome I of upper limb
Use for CRPS Type 1 affecting the upper limb.
Applicable To
- Reflex sympathetic dystrophy of upper limb
Excludes
- CRPS Type 2 (G56.4-)
Clinical Validation Requirements
- Persistent burning pain in upper limb
- Temperature asymmetry documented by thermography
- No major nerve injury
Coding Notes
Document specific autonomic changes and absence of nerve injury.
G90.52 - Complex regional pain syndrome I of lower limb
Use for CRPS Type 1 affecting the lower limb.
Applicable To
- Reflex sympathetic dystrophy of lower limb
Excludes
- CRPS Type 2 (G57.7-)
Clinical Validation Requirements
- Persistent burning pain in lower limb
- Temperature asymmetry documented by thermography
- No major nerve injury
Coding Notes
Document specific autonomic changes and absence of nerve injury.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Reflex Sympathetic Dystrophy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G90.50.
Impact
Clinical: May lead to incorrect diagnosis of CRPS Type 2., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims due to incorrect coding.
Mitigation Strategy
Include EMG or nerve conduction study results in documentation.
Impact
Reimbursement: May lead to reduced reimbursement rates., Compliance: Non-compliance with coding specificity requirements., Data Quality: Decreases the accuracy of clinical data.
Mitigation Strategy
Ensure specific laterality is coded when available.
Impact
Risk of audits due to use of unspecified codes when specific codes are applicable.
Mitigation Strategy
Ensure documentation supports the use of specific codes.
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 Reflex Sympathetic Dystrophy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Reflex Sympathetic Dystrophy
Use these documentation templates to ensure complete and accurate documentation for Reflex Sympathetic Dystrophy. These templates include all required elements for proper coding and billing.
CRPS Type 1 affecting the lower limb
Specialty: NeurologyRequired Elements
- Subjective pain description
- Objective signs of autonomic changes
- Temperature asymmetry measurements
- Absence of major nerve injury
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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