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ICD-10 Guide
ICD-10 CodesG90.5

G90.5

Billable

Complex regional pain syndrome I (CRPS I)

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

Code Description

ICD-10 G90.5 is a billable code used to indicate a diagnosis of complex regional pain syndrome i (crps i).

Key Diagnostic Point:

Complex Regional Pain Syndrome I (CRPS I) is a chronic pain condition that typically affects a limb following an injury or surgery. It is characterized by severe pain, swelling, and changes in the skin, often accompanied by autonomic dysfunction. The pain is disproportionate to the initial injury and may spread to other areas of the body. CRPS I is distinguished from CRPS II, which involves identifiable nerve injury. The condition is believed to result from a malfunction in the peripheral and central nervous systems, leading to an exaggerated response to pain signals. Symptoms may include allodynia (pain from stimuli that do not normally provoke pain), hyperalgesia (increased sensitivity to pain), and changes in skin temperature and color. Diagnosis is primarily clinical, supported by patient history and physical examination, and may involve imaging studies to rule out other conditions. Treatment often includes pain management strategies, physical therapy, and psychological support, but the prognosis can vary significantly among individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Varied presentation of symptoms among patients
  • Need for comprehensive documentation of pain severity and functional impairment
  • Potential overlap with other pain syndromes
  • Requirement for multidisciplinary treatment approaches

Audit Risk Factors

  • Inadequate documentation of pain severity and duration
  • Failure to document the impact on daily activities
  • Misclassification with other pain syndromes
  • Lack of evidence for treatment efficacy

Specialty Focus

Medical Specialties

Pain Management

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with chronic pain following trauma or surgery.

Billing Considerations

Documentation must clearly outline the relationship between the injury and the onset of CRPS I.

Neurology

Documentation Requirements

Neurological evaluations, imaging studies, and differential diagnosis documentation.

Common Clinical Scenarios

Patients with neurological symptoms following limb injuries.

Billing Considerations

Must differentiate between CRPS I and other neuropathic pain conditions.

Coding Guidelines

Inclusion Criteria

Use G90.5 When
  • According to ICD
  • 10 guidelines, G90
  • 5 should be used when the patient exhibits symptoms consistent with CRPS I without identifiable nerve injury
  • Documentation must support the diagnosis, including symptom duration and severity

Exclusion Criteria

Do NOT use G90.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

97001CPT Code

Physical therapy evaluation

Clinical Scenario

Used for initial assessment of CRPS I patients.

Documentation Requirements

Detailed evaluation of functional limitations and pain levels.

Specialty Considerations

Physical therapists should document treatment goals and progress.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of CRPS, improving the ability to capture the complexity of the condition and its management. This specificity aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of CRPS, improving the ability to capture the complexity of the condition and its management. This specificity aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of CRPS, improving the ability to capture the complexity of the condition and its management. This specificity aids in better tracking of treatment outcomes and resource allocation.

Resources

Clinical References

  • •
    American Academy of Pain Medicine

Coding & Billing References

  • •
    American Academy of Pain Medicine

Frequently Asked Questions

What is the difference between CRPS I and CRPS II?

CRPS I occurs without identifiable nerve injury, while CRPS II is associated with a specific nerve injury. Both conditions present with similar symptoms, but the underlying causes differ.