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v1.0.0
ICD-10 Guide
ICD-10 CodesG56.41

G56.41

Billable

Causalgia of right upper limb

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

Code Description

ICD-10 G56.41 is a billable code used to indicate a diagnosis of causalgia of right upper limb.

Key Diagnostic Point:

Causalgia, also known as complex regional pain syndrome type II, is characterized by severe, persistent pain that typically follows a nerve injury. In the case of G56.41, the pain is localized to the right upper limb, often accompanied by sensory abnormalities such as hyperesthesia or allodynia. The condition arises from damage to peripheral nerves, leading to a dysregulation of pain signaling pathways. Patients may experience not only pain but also changes in skin color, temperature, and swelling in the affected limb. Diagnosis is primarily clinical, supported by patient history and physical examination, and may involve nerve conduction studies to assess the integrity of the affected nerve. Treatment often includes pain management strategies, physical therapy, and in some cases, surgical intervention to relieve nerve compression or injury. Understanding the underlying nerve pathology is crucial for effective management and coding of this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of nerve injury and pain syndromes
  • Differentiation from other neuropathic pain conditions
  • Documentation of specific symptoms and nerve involvement
  • Potential for co-morbid conditions affecting coding

Audit Risk Factors

  • Inadequate documentation of nerve injury
  • Failure to specify laterality (right vs. left)
  • Misclassification of causalgia as other pain syndromes
  • Lack of supporting diagnostic tests in the medical record

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, including sensory and motor assessments.

Common Clinical Scenarios

Patients presenting with chronic pain following a traumatic nerve injury or surgery.

Billing Considerations

Documentation must clearly outline the relationship between the nerve injury and the causalgia symptoms.

Pain Management

Documentation Requirements

Comprehensive pain assessments, treatment plans, and response to therapies.

Common Clinical Scenarios

Management of chronic pain syndromes with a focus on multimodal pain relief strategies.

Billing Considerations

Documentation should include the effectiveness of pain management interventions and any changes in patient condition.

Coding Guidelines

Inclusion Criteria

Use G56.41 When
  • According to ICD
  • 10 coding guidelines, G56
  • 41 should be used when there is clear documentation of causalgia localized to the right upper limb following a nerve injury
  • It is important to ensure that the documentation supports the diagnosis and includes details about the nature of the pain and any associated symptoms

Exclusion Criteria

Do NOT use G56.41 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95903CPT Code

Nerve conduction study, upper limb

Clinical Scenario

Used to evaluate nerve function in patients with suspected causalgia.

Documentation Requirements

Document the rationale for the nerve conduction study and findings.

Specialty Considerations

Neurologists should ensure that the study correlates with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of causalgia, improving the accuracy of diagnoses and treatment plans. The granularity of ICD-10 codes helps in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of causalgia, improving the accuracy of diagnoses and treatment plans. The granularity of ICD-10 codes helps in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement.

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

What is causalgia?

Causalgia is a chronic pain condition that occurs after a nerve injury, characterized by severe burning pain and sensory abnormalities in the affected area.

How is causalgia diagnosed?

Diagnosis is primarily clinical, based on patient history and physical examination, and may be supported by nerve conduction studies to assess nerve function.

What treatments are available for causalgia?

Treatment options include pain management strategies, physical therapy, and in some cases, surgical intervention to relieve nerve compression.