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ICD-10 Guide
ICD-10 CodesChapter 6: Diseases of the nervous systemG55

G55

Billable

Nerve root and plexus compressions in diseases classified elsewhere

Chapter 6:Diseases of the nervous system

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

Code Description

ICD-10 G55 is a billable code used to indicate a diagnosis of nerve root and plexus compressions in diseases classified elsewhere.

Key Diagnostic Point:

G55 refers to nerve root and plexus compressions that occur as a result of diseases classified in other categories. This code is often used when a patient presents with symptoms of nerve compression, such as pain, numbness, or weakness, but the underlying cause is attributed to a different disease process. Common conditions leading to nerve root and plexus compression include tumors, herniated discs, or systemic diseases like diabetes that may lead to neuropathies. Clinicians must carefully evaluate the patient's history and perform a thorough neurological examination to determine the specific nerve affected and the underlying disease causing the compression. Diagnostic imaging, such as MRI or CT scans, may be necessary to visualize the anatomical structures and confirm the diagnosis. Accurate coding requires a clear understanding of the primary disease process and its relationship to the nerve compression symptoms, ensuring that the G55 code is appropriately applied in the context of the patient's overall clinical picture.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of underlying diseases causing nerve compression.
  • Differentiation between primary and secondary conditions is necessary.
  • Documentation must clearly link symptoms to the underlying disease.
  • Potential for multiple codes to be applicable based on patient presentation.

Audit Risk Factors

  • Inadequate documentation linking symptoms to the underlying disease.
  • Misuse of G55 when a more specific code is available.
  • Failure to document diagnostic imaging results.
  • Inconsistent clinical findings in the medical record.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, imaging results, and correlation with symptoms.

Common Clinical Scenarios

Patients with radiculopathy due to herniated discs or tumors compressing nerve roots.

Billing Considerations

Ensure that the primary disease is well-documented to justify the use of G55.

Orthopedics

Documentation Requirements

Surgical notes, imaging studies, and pre-operative assessments.

Common Clinical Scenarios

Patients undergoing surgery for decompression of nerve roots due to structural abnormalities.

Billing Considerations

Document the relationship between orthopedic conditions and nerve compression.

Coding Guidelines

Inclusion Criteria

Use G55 When
  • According to ICD
  • 10 guidelines, G55 should be used when nerve root and plexus compressions are secondary to diseases classified elsewhere
  • Coders must ensure that the primary condition is documented and that G55 is not used as a primary diagnosis

Exclusion Criteria

Do NOT use G55 When
No specific exclusions found.

Related CPT Codes

62263CPT Code

Decompression of nerve root

Clinical Scenario

Used when surgical intervention is performed for nerve root compression.

Documentation Requirements

Surgical notes detailing the procedure and indication for surgery.

Specialty Considerations

Orthopedic or neurosurgical documentation must clearly link the procedure to the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of nerve root and plexus compressions, improving the ability to capture the complexity of these conditions and their underlying causes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of nerve root and plexus compressions, improving the ability to capture the complexity of these conditions and their underlying causes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of nerve root and plexus compressions, improving the ability to capture the complexity of these conditions and their underlying causes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

When should I use G55 instead of G56?

Use G55 when the nerve root or plexus compression is secondary to another disease process, while G56 should be used for peripheral neuropathies not related to compressive causes.