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ICD-10 Guide
ICD-10 CodesG90.50

G90.50

Billable

Complex regional pain syndrome I, unspecified

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

Code Description

ICD-10 G90.50 is a billable code used to indicate a diagnosis of complex regional pain syndrome i, unspecified.

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. The pain is often disproportionate to the initial injury and can be accompanied by various symptoms including swelling, changes in skin color and temperature, and abnormal sweating. The exact pathophysiology of CRPS I is not fully understood, but it is believed to involve a combination of peripheral and central nervous system changes, leading to an exaggerated pain response. Patients may experience allodynia (pain from stimuli that do not normally provoke pain), hyperalgesia (increased sensitivity to pain), and motor dysfunction. Diagnosis is primarily clinical, based on the presence of characteristic symptoms and the exclusion of other conditions. Treatment often involves a multidisciplinary approach, including pain management, physical therapy, and psychological support. Early intervention is crucial to improve outcomes and prevent long-term disability.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Varied presentation of symptoms can lead to misdiagnosis.
  • Overlap with other pain syndromes complicates coding.
  • Need for comprehensive documentation to support diagnosis.
  • Potential for chronicity and recurrence requires careful tracking.

Audit Risk Factors

  • Inadequate documentation of symptoms and treatment.
  • Failure to differentiate between CRPS I and CRPS II.
  • Lack of evidence for chronicity in patient records.
  • Misuse of unspecified codes when more specific codes are available.

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, requiring multidisciplinary management.

Billing Considerations

Documentation must clearly outline the relationship between the injury and the onset of symptoms.

Neurology

Documentation Requirements

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

Common Clinical Scenarios

Patients with neurological symptoms following trauma, requiring differential diagnosis.

Billing Considerations

Neurological assessments must be thorough to rule out other conditions.

Coding Guidelines

Inclusion Criteria

Use G90.50 When
  • According to ICD
  • 10 guidelines, G90
  • 50 should be used when the specific type of CRPS is not documented
  • It is essential to ensure that the diagnosis is supported by clinical findings and that other potential causes of pain have been ruled out

Exclusion Criteria

Do NOT use G90.50 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 I symptoms.

Documentation Requirements

Detailed evaluation of pain, function, and treatment goals.

Specialty Considerations

Physical therapists should document the impact of CRPS on mobility and daily activities.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of pain syndromes, including CRPS I. This specificity aids in better tracking of treatment outcomes and resource allocation, although it requires more detailed documentation from providers.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of pain syndromes, including CRPS I. This specificity aids in better tracking of treatment outcomes and resource allocation, although it requires more detailed documentation from providers.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of pain syndromes, including CRPS I. This specificity aids in better tracking of treatment outcomes and resource allocation, although it requires more detailed documentation from providers.

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 a confirmed nerve injury, while CRPS II is associated with a specific nerve injury. The coding and documentation requirements differ based on this distinction.