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ICD-10 Guide
ICD-10 CodesG54.6

G54.6

Billable

Phantom limb syndrome with pain

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G54.6 is a billable code used to indicate a diagnosis of phantom limb syndrome with pain.

Key Diagnostic Point:

Phantom limb syndrome with pain is a neurological condition that occurs in individuals who have undergone amputation of a limb. Patients often experience sensations, including pain, in the area where the limb once was, despite the absence of the physical limb. This phenomenon is believed to arise from the brain's representation of the body, which continues to perceive the missing limb. The pain can be sharp, burning, or cramping and may vary in intensity. The underlying mechanisms involve complex interactions between the peripheral and central nervous systems, including changes in nerve pathways and cortical reorganization. Patients may also experience other sensations such as itching or tingling in the phantom limb. Treatment options include medications, physical therapy, and psychological support, but the effectiveness can vary significantly among individuals. Understanding the pathophysiology of phantom limb pain is crucial for developing effective management strategies and improving the quality of life for affected patients.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in patient symptoms and experiences
  • Need for comprehensive documentation of pain characteristics
  • Potential overlap with other neuropathic pain conditions
  • Challenges in distinguishing phantom limb pain from other pain syndromes

Audit Risk Factors

  • Inadequate documentation of pain severity and characteristics
  • Failure to differentiate from other neuropathic pain conditions
  • Lack of interdisciplinary treatment documentation
  • Misuse of the code in cases without amputation

Specialty Focus

Medical Specialties

Pain Management

Documentation Requirements

Detailed documentation of pain characteristics, treatment plans, and patient responses.

Common Clinical Scenarios

Management of chronic pain in amputees, including medication adjustments and therapy.

Billing Considerations

Consideration of psychological factors and the need for a multidisciplinary approach.

Neurology

Documentation Requirements

Comprehensive neurological assessments and documentation of sensory experiences.

Common Clinical Scenarios

Evaluation of phantom limb sensations and differential diagnosis of neuropathic pain.

Billing Considerations

Understanding of the neuroanatomy involved in phantom limb sensations.

Coding Guidelines

Inclusion Criteria

Use G54.6 When
  • According to ICD
  • 10 guidelines, G54
  • 6 should be used when the patient has a documented history of limb amputation and presents with phantom limb pain
  • It is essential to ensure that the pain is specifically attributed to the phantom limb and not to other conditions

Exclusion Criteria

Do NOT use G54.6 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97003CPT Code

Physical therapy evaluation

Clinical Scenario

Used for assessing the impact of phantom limb pain on mobility and function.

Documentation Requirements

Detailed evaluation notes and treatment plan.

Specialty Considerations

Physical therapists should document specific interventions aimed at managing phantom limb pain.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like phantom limb syndrome, improving the accuracy of patient records and facilitating better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like phantom limb syndrome, improving the accuracy of patient records and facilitating better treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like phantom limb syndrome, improving the accuracy of patient records and facilitating better treatment planning.

Resources

Clinical References

  • •
    American Academy of Neurology

Coding & Billing References

  • •
    American Academy of Neurology

Frequently Asked Questions

What is the primary cause of phantom limb pain?

Phantom limb pain is primarily caused by the brain's continued representation of the missing limb, leading to misinterpretation of sensory signals from the nervous system.