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v1.0.0
ICD-10 Guide
ICD-10 CodesG90.519

G90.519

Billable

Complex regional pain syndrome I of unspecified upper limb

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

Code Description

ICD-10 G90.519 is a billable code used to indicate a diagnosis of complex regional pain syndrome i of unspecified 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 surgery. The pain is disproportionate to the initial injury and is often accompanied by sensory, motor, and autonomic dysfunction. In the case of CRPS I of the unspecified upper limb, the pain is localized to the upper extremity without identifiable nerve injury. Patients may experience symptoms such as burning pain, swelling, changes in skin color and temperature, and abnormal sweating. The pathophysiology of CRPS involves a complex interplay of peripheral and central nervous system mechanisms, leading to heightened pain perception and autonomic dysregulation. Diagnosis is primarily clinical, based on symptomatology and the exclusion of other conditions. Treatment often includes pain management strategies, physical therapy, and sometimes psychological support. Early intervention is crucial to improve outcomes and prevent long-term disability.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation and severity
  • Need for comprehensive clinical documentation
  • Differentiation from other pain syndromes
  • Potential for co-morbid conditions

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Failure to specify the affected limb
  • Misdiagnosis 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 therapy.

Common Clinical Scenarios

Patients presenting with chronic pain following an upper limb injury or surgery.

Billing Considerations

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

Neurology

Documentation Requirements

Neurological evaluations, imaging studies, and differential diagnosis documentation.

Common Clinical Scenarios

Patients with neurological symptoms following trauma to the upper limb.

Billing Considerations

Consideration of other neurological disorders that may mimic CRPS symptoms.

Coding Guidelines

Inclusion Criteria

Use G90.519 When
  • According to ICD
  • 10 guidelines, CRPS I is classified under G90
  • 5, with G90
  • 519 specifically indicating involvement of the upper limb
  • Coders must ensure that documentation supports the diagnosis and that other potential causes of pain are ruled out

Exclusion Criteria

Do NOT use G90.519 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 symptoms.

Documentation Requirements

Detailed evaluation of pain, function, and treatment goals.

Specialty Considerations

Physical therapists should document the specific functional limitations related to CRPS.

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 track and manage this complex condition. It emphasizes the need for detailed documentation to support the diagnosis and treatment.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of CRPS, improving the ability to track and manage this complex condition. It emphasizes the need for detailed documentation to support the diagnosis and treatment.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of CRPS, improving the ability to track and manage this complex condition. It emphasizes the need for detailed documentation to support the diagnosis and treatment.

Resources

Clinical References

  • •
    American Academy of Neurology - CRPS Guidelines

Coding & Billing References

  • •
    American Academy of Neurology - CRPS Guidelines

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 confirmed nerve injury. Both conditions present with similar symptoms but differ in their underlying causes.