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ICD-10 Guide
ICD-10 CodesG90.52

G90.52

Billable

Complex regional pain syndrome I of lower limb

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

Code Description

ICD-10 G90.52 is a billable code used to indicate a diagnosis of complex regional pain syndrome i of lower limb.

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 following an injury or surgery. In the case of CRPS I of the lower limb, the syndrome manifests with severe, persistent pain that is disproportionate to the initial injury. Patients may experience a range of symptoms including swelling, changes in skin color and temperature, and abnormal sweating in the affected limb. The pain is often described as burning or throbbing and can be accompanied by motor dysfunction, such as weakness or tremors. The exact pathophysiology of CRPS is not fully understood, but it is believed to involve a combination of peripheral and central nervous system changes, leading to an exaggerated response to pain signals. Diagnosis is primarily clinical, based on the history of pain and associated symptoms, and may be supported by imaging studies or nerve conduction tests. Early recognition and intervention are crucial to improve outcomes and reduce the risk of long-term disability.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Varied presentation of symptoms can complicate diagnosis.
  • Overlap with other pain syndromes may lead to miscoding.
  • Requires detailed documentation of symptomatology and history.
  • Potential for co-morbid conditions that must be accurately coded.

Audit Risk Factors

  • Inadequate documentation of symptom severity and duration.
  • Failure to document prior treatments or interventions.
  • Misidentification of CRPS I versus CRPS II.
  • Inconsistent coding of co-morbid conditions.

Specialty Focus

Medical Specialties

Pain Management

Documentation Requirements

Detailed pain assessments, treatment history, and response to therapies.

Common Clinical Scenarios

Patients presenting with chronic pain following trauma or surgery.

Billing Considerations

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

Neurology

Documentation Requirements

Neurological evaluations, imaging studies, and differential diagnoses.

Common Clinical Scenarios

Patients with neurological symptoms following lower limb injuries.

Billing Considerations

Must differentiate between CRPS and other neurological disorders that may present similarly.

Coding Guidelines

Inclusion Criteria

Use G90.52 When
  • According to ICD
  • 10 guidelines, CRPS I is classified under G90
  • 5, with G90
  • 52 specifically indicating the lower limb
  • Coders must ensure that the documentation supports the diagnosis, including the presence of characteristic symptoms and the absence of identifiable nerve injury

Exclusion Criteria

Do NOT use G90.52 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

64450CPT Code

Injection, anesthetic agent into a major nerve or plexus

Clinical Scenario

Used for pain management in patients diagnosed with CRPS I.

Documentation Requirements

Document the specific nerve targeted and the patient's response to previous treatments.

Specialty Considerations

Pain management specialists should ensure comprehensive pain assessments are included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of CRPS, improving the accuracy of data collection and reimbursement processes. The granularity of ICD-10 codes helps in better tracking of treatment outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of CRPS, improving the accuracy of data collection and reimbursement processes. The granularity of ICD-10 codes helps in better tracking of treatment outcomes and resource utilization.

Reimbursement & Billing Impact

reimbursement processes. The granularity of ICD-10 codes helps in better tracking of treatment outcomes and resource utilization.

Resources

Clinical References

  • •
    American Academy of Pain Medicine

Coding & Billing References

  • •
    American Academy of Pain Medicine

Frequently Asked Questions

What are the primary symptoms of CRPS I?

The primary symptoms of CRPS I include severe pain, swelling, changes in skin color and temperature, and motor dysfunction in the affected limb.