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ICD-10 Guide
ICD-10 CodesG56.4

G56.4

Billable

Causalgia of upper limb

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

Code Description

ICD-10 G56.4 is a billable code used to indicate a diagnosis of causalgia of upper limb.

Key Diagnostic Point:

Causalgia of the upper limb, classified under G56.4, is a complex pain syndrome characterized by severe burning pain, typically following a nerve injury. This condition often arises after trauma or surgery affecting the peripheral nerves, particularly in the upper extremities. Patients may experience allodynia, hyperalgesia, and changes in skin temperature and color. The pain is often disproportionate to the initial injury and can be accompanied by sensory and motor deficits. Causalgia is part of the broader category of complex regional pain syndrome (CRPS), which includes both CRPS I (reflex sympathetic dystrophy) and CRPS II (causalgia). Diagnosis is primarily clinical, supported by patient history and physical examination, and may involve nerve conduction studies to assess the integrity of the affected nerves. Treatment options include pharmacotherapy, physical therapy, and in some cases, surgical interventions. Understanding the nuances of causalgia is essential for accurate coding and appropriate management of affected patients.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms
  • Need for comprehensive documentation of nerve injury and pain characteristics
  • Differentiation from other neuropathic pain conditions
  • Potential for co-morbid conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the affected nerve or region
  • Misclassification of causalgia as a simpler neuropathy
  • Lack of supporting diagnostic tests in the medical record

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, including sensory and motor assessments.

Common Clinical Scenarios

Patients presenting with chronic pain following upper limb trauma or surgery.

Billing Considerations

Neurologists should document the specific nerve involved and any diagnostic tests performed.

Pain Management

Documentation Requirements

Comprehensive pain assessments, treatment plans, and response to therapies.

Common Clinical Scenarios

Management of patients with chronic pain syndromes, including causalgia.

Billing Considerations

Pain specialists should document the impact of pain on daily activities and quality of life.

Coding Guidelines

Inclusion Criteria

Use G56.4 When
  • According to ICD
  • 10 guidelines, G56
  • 4 should be used when there is a clear diagnosis of causalgia affecting the upper limb
  • It is essential to document the specific nerve involved and any associated conditions

Exclusion Criteria

Do NOT use G56.4 When
  • Exclusion criteria include conditions that do not meet the definition of causalgia or are better classified under other neuropathic pain codes

Related ICD-10 Codes

Related CPT Codes

95903CPT Code

Nerve conduction study, motor and sensory

Clinical Scenario

Used to evaluate nerve function in patients with suspected causalgia.

Documentation Requirements

Document the specific nerves tested and the rationale for the study.

Specialty Considerations

Neurologists should correlate findings with clinical symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of causalgia, improving the ability to capture the complexity of the condition and its impact on patient care. This specificity aids in better treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of causalgia, improving the ability to capture the complexity of the condition and its impact on patient care. This specificity aids in better treatment planning and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of causalgia, improving the ability to capture the complexity of the condition and its impact on patient care. This specificity aids in better treatment planning and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the primary cause of causalgia?

Causalgia is primarily caused by nerve injury, often following trauma or surgical procedures, leading to abnormal pain signaling.

How is causalgia diagnosed?

Diagnosis is based on clinical evaluation, patient history, and may include nerve conduction studies to assess nerve function.