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v1.0.0
ICD-10 Guide
ICD-10 CodesG90.59

G90.59

Billable

Complex regional pain syndrome I of other specified site

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

Code Description

ICD-10 G90.59 is a billable code used to indicate a diagnosis of complex regional pain syndrome i of other specified site.

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. It is characterized by severe pain, swelling, and changes in the skin. The pain is often disproportionate to the initial injury and can spread to other areas of the body. CRPS I is distinguished from CRPS II, which involves identifiable nerve injury. The condition is thought to involve a malfunction of the peripheral and central nervous systems, leading to abnormal pain signaling and autonomic dysfunction. 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, based on history and physical examination, and may involve imaging studies to rule out other conditions. Treatment often includes pain management strategies, physical therapy, and sometimes psychological support. The 'other specified site' designation indicates that the affected area does not fall into the commonly documented sites such as the upper or lower extremities, necessitating careful documentation to specify the location of symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of symptoms that can mimic other conditions
  • Need for detailed documentation of pain characteristics and location
  • Potential for co-morbid conditions affecting pain perception
  • Variability in treatment approaches and responses

Audit Risk Factors

  • Inadequate documentation of the specific site affected
  • Failure to document the severity and nature of pain
  • Lack of evidence for treatment modalities used
  • Inconsistent coding with clinical notes

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 an injury or surgery.

Billing Considerations

Ensure comprehensive documentation of pain characteristics and treatment efficacy.

Neurology

Documentation Requirements

Neurological assessments, imaging results, and differential diagnoses.

Common Clinical Scenarios

Patients with neurological symptoms following trauma or surgery.

Billing Considerations

Document any neurological deficits and their relation to CRPS symptoms.

Coding Guidelines

Inclusion Criteria

Use G90.59 When
  • According to ICD
  • 10 guidelines, G90
  • 59 should be used when the specific site of CRPS I is documented
  • It is important to ensure that the diagnosis is supported by clinical findings and that the symptoms align with the criteria for CRPS

Exclusion Criteria

Do NOT use G90.59 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

64450CPT Code

Injection, anesthetic agent into a major nerve or branch

Clinical Scenario

Used for pain management in CRPS I cases.

Documentation Requirements

Document the site of injection and response to treatment.

Specialty Considerations

Pain management specialists should ensure proper coding based on the specific nerve targeted.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of CRPS, enabling better tracking of the condition and its management. G90.59 provides a means to specify the site affected, which can enhance treatment planning and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of CRPS, enabling better tracking of the condition and its management. G90.59 provides a means to specify the site affected, which can enhance treatment planning and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of CRPS, enabling better tracking of the condition and its management. G90.59 provides a means to specify the site affected, which can enhance treatment planning and outcomes.

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 confirmed nerve injury. Both conditions present with similar symptoms, but the underlying causes differ.