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v1.0.0
ICD-10 Guide
ICD-10 CodesG56.43

G56.43

Billable

Causalgia of bilateral upper limbs

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

Code Description

ICD-10 G56.43 is a billable code used to indicate a diagnosis of causalgia of bilateral upper limbs.

Key Diagnostic Point:

Causalgia, also known as complex regional pain syndrome type II, is characterized by severe, burning pain typically following a nerve injury. In the case of bilateral upper limbs, this condition may arise from various etiologies, including trauma, surgery, or nerve entrapment syndromes affecting both arms. Patients often report allodynia, hyperalgesia, and changes in skin temperature and color. The pain can be debilitating, impacting daily activities and quality of life. Diagnosis is primarily clinical, supported by patient history and physical examination, with nerve conduction studies often employed to assess the integrity of the affected nerves. Treatment may include medications, physical therapy, and in some cases, nerve blocks or surgical interventions. The bilateral nature of the condition can complicate management and requires careful consideration of underlying causes, such as systemic diseases or bilateral nerve entrapments.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Bilateral involvement complicates diagnosis and treatment planning.
  • Differentiating causalgia from other neuropathic pain syndromes.
  • Need for comprehensive documentation of symptoms and treatment response.
  • Potential overlap with other ICD-10 codes related to neuropathy.

Audit Risk Factors

  • Insufficient documentation of bilateral symptoms.
  • Failure to document the underlying cause of causalgia.
  • Inadequate detail in treatment plans and responses.
  • Misuse of related codes leading to incorrect billing.

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 nerve injury or surgery.

Billing Considerations

Documenting the severity and impact of pain on daily activities is crucial.

Pain Management

Documentation Requirements

Comprehensive pain assessments, including pain scales and treatment efficacy.

Common Clinical Scenarios

Management of chronic pain syndromes with multimodal treatment approaches.

Billing Considerations

Documenting the response to interventions and any side effects of medications.

Coding Guidelines

Inclusion Criteria

Use G56.43 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the bilateral nature of the condition
  • Include details of the underlying cause and any associated conditions

Exclusion Criteria

Do NOT use G56.43 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95903CPT Code

Nerve conduction study, motor and sensory

Clinical Scenario

Used to evaluate nerve function in patients with suspected causalgia.

Documentation Requirements

Document the rationale for the study and findings.

Specialty Considerations

Neurologists should ensure comprehensive reports are available.

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 data collection and reimbursement processes. G56.43 provides a clear distinction for bilateral cases, which was less defined in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of causalgia, improving the accuracy of data collection and reimbursement processes. G56.43 provides a clear distinction for bilateral cases, which was less defined in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. G56.43 provides a clear distinction for bilateral cases, which was less defined in ICD-9.

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 severe burning pain that typically follows a nerve injury, often associated with changes in skin temperature and color.

How is causalgia diagnosed?

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

What are common treatments for causalgia?

Treatment may include medications, physical therapy, nerve blocks, and in some cases, surgical interventions.