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v1.0.0
ICD-10 Guide
ICD-10 CodesG90.511

G90.511

Billable

Complex regional pain syndrome I of right upper limb

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

Code Description

ICD-10 G90.511 is a billable code used to indicate a diagnosis of complex regional pain syndrome i of right upper limb.

Key Diagnostic Point:

Complex Regional Pain Syndrome (CRPS) I, previously known as Reflex Sympathetic Dystrophy (RSD), is a chronic pain condition that typically affects a limb following an injury or trauma. CRPS I is characterized by severe, persistent pain that is disproportionate to the initial injury, often accompanied by sensory, motor, and autonomic dysfunction. In the case of G90.511, the syndrome specifically affects the right upper limb. Patients may experience symptoms such as burning pain, swelling, changes in skin color and temperature, and abnormal sweating. The pain is often described as a burning sensation and can be exacerbated by movement or touch. The exact pathophysiology of CRPS is not fully understood, but it is believed to involve a combination of peripheral and central nervous system changes, including neurogenic inflammation and altered pain processing. Diagnosis is primarily clinical, based on patient history and symptomatology, and may be supported by imaging studies or nerve conduction tests. Early diagnosis and intervention are crucial for improving outcomes and may include physical therapy, pain management strategies, and, in some cases, sympathetic nerve blocks.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Varied presentation of symptoms among patients
  • Need for comprehensive patient history and symptom documentation
  • Differentiation from other pain syndromes
  • Potential for co-morbid conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of symptom severity and duration
  • Failure to document the specific limb affected
  • Lack of evidence for treatment interventions
  • Misclassification of CRPS type (I vs. II)

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 pain characteristics and any functional limitations.

Neurology

Documentation Requirements

Neurological evaluations, imaging results, and differential diagnoses.

Common Clinical Scenarios

Patients with unexplained pain and neurological symptoms following an injury.

Billing Considerations

Must differentiate from other neurological disorders and document any neurological deficits.

Coding Guidelines

Inclusion Criteria

Use G90.511 When
  • According to the ICD
  • CM coding guidelines, G90
  • 511 should be used when the condition is specifically diagnosed as CRPS I affecting the right upper limb
  • Coders must ensure that the documentation supports the diagnosis and that the symptoms align with the criteria for CRPS

Exclusion Criteria

Do NOT use G90.511 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

64450CPT Code

Injection, anesthetic agent into sympathetic nerve

Clinical Scenario

Used for pain management in CRPS patients.

Documentation Requirements

Document the indication for the injection and patient response.

Specialty Considerations

Pain management specialists should ensure thorough documentation of treatment efficacy.

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 CRPS, improving the accuracy of data collection and reimbursement processes. G90.511 provides specificity that was not available in ICD-9, enhancing clinical understanding and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like CRPS, improving the accuracy of data collection and reimbursement processes. G90.511 provides specificity that was not available in ICD-9, enhancing clinical understanding and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. G90.511 provides specificity that was not available in ICD-9, enhancing clinical understanding and treatment planning.

Resources

Clinical References

  • •
    American Academy of Pain Medicine

Coding & Billing References

  • •
    American Academy of Pain Medicine

Frequently Asked Questions

What are the primary symptoms of CRPS I?

The primary symptoms include severe pain, swelling, changes in skin color and temperature, and abnormal sweating in the affected limb.

How is CRPS I diagnosed?

Diagnosis is primarily clinical, based on patient history and symptomatology, and may be supported by imaging studies or nerve conduction tests.

What treatments are available for CRPS I?

Treatment options include physical therapy, pain management strategies, and sympathetic nerve blocks, depending on the severity and duration of symptoms.