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v1.0.0
ICD-10 Guide
ICD-10 CodesG90.523

G90.523

Billable

Complex regional pain syndrome I of lower limb, bilateral

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

Code Description

ICD-10 G90.523 is a billable code used to indicate a diagnosis of complex regional pain syndrome i of lower limb, bilateral.

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 after an injury or surgery. In the case of G90.523, the syndrome manifests bilaterally in the lower limbs. Patients often experience severe, persistent pain that is disproportionate to the initial injury. Symptoms may include swelling, changes in skin color and temperature, and abnormal sweating. The pain is often described as burning or throbbing and can be accompanied by motor dysfunction, such as weakness or tremors. 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 dysregulation of the autonomic nervous system. Diagnosis is primarily clinical, based on patient history and symptomatology, and may be supported by imaging studies or nerve conduction tests. Treatment typically involves a multidisciplinary approach, including pain management, physical therapy, and psychological support.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptom presentation among patients
  • Need for comprehensive documentation of pain severity and functional impairment
  • Differentiation from other pain syndromes and conditions
  • Potential for co-morbid conditions that may complicate coding

Audit Risk Factors

  • Inadequate documentation of bilateral symptoms
  • Failure to document the initial injury or surgery
  • Lack of evidence for ongoing treatment and management
  • 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 surgery or trauma.

Billing Considerations

Documentation must clearly outline the bilateral nature of the condition and any functional limitations.

Neurology

Documentation Requirements

Neurological evaluations, imaging studies, and assessments of autonomic function.

Common Clinical Scenarios

Patients with neurological symptoms following an injury, requiring differential diagnosis.

Billing Considerations

Neurological assessments should include detailed descriptions of sensory and motor deficits.

Coding Guidelines

Inclusion Criteria

Use G90.523 When
  • According to ICD
  • 10 guidelines, G90
  • 523 should be used when the clinical documentation specifies complex regional pain syndrome I affecting both lower limbs
  • It is essential to ensure that the bilateral nature of the condition is clearly documented to support the use of this specific code

Exclusion Criteria

Do NOT use G90.523 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 and functional limitations.

Documentation Requirements

Detailed evaluation of pain, range of motion, and functional status.

Specialty Considerations

Physical therapists should document specific interventions and patient responses.

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, enabling better tracking of treatment outcomes and resource allocation. G90.523 provides a clear distinction for bilateral involvement, which was less defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like CRPS, enabling better tracking of treatment outcomes and resource allocation. G90.523 provides a clear distinction for bilateral involvement, which was less defined in ICD-9.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like CRPS, enabling better tracking of treatment outcomes and resource allocation. G90.523 provides a clear distinction for bilateral involvement, which was less defined in ICD-9.

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 confirmed nerve injury, while CRPS II is associated with a specific nerve injury. Both conditions present with similar symptoms, but the underlying causes differ.