Neurology & Pain Management Coding Alert

Presence or absence of pain guides you to the right code for phantom limb

In 2013, you will need to gather more details about the presence or absence of pain when the patient complains of a phantom limb after an amputation. Whereas ICD-9 has a single code for phantom limb syndrome, ICD-10 elaborates the relation of phantom limb to pain and specifies two codes for the condition depending upon pain is present or not.

ICD Codes

ICD-9 has a single code for phantom limb, 353.6 (Phantom limb [syndrome]). When reporting the same in ICD-10, you will need to look for the presence or absence of pain to determine the right code. There are accordingly two ICD-10 codes for phantom limb.

• G54.6 (Phantom limb syndrome with pain)
• G54.7 (Phantom limb syndrome without pain)

What is a Phantom Limb?

Phantom limb is a condition wherein the patient reports a feeling of the amputated limb being still attached to the body. Some patients even feel that the virtual limb is moving in synchronization with the other body parts. This condition is very common and more than half of patients undergoing the amputation for whatever reason report experiencing a phantom limb.

Are All Phantom Limbs Painful?

Phantom limbs may be accompanied by varying sensations and even pain. The patient may describe the phantom limb is shorter and has sensations like itching, twitching, and pricking. Not all phantom limb sensations are painful. Phantom pains occur when the nerves that otherwise would have supplied the existing limb are irritated to generate the sensation of pain. The frequency and intensity of pain however varies. The pain can be made worse by anxiety, stress, and a change in weather or temperature. Patients variously describe the pain in terms of the limb feeling to be in a distorted and painful position.

Read Through What the Patient Complains

Pain in phantom limb has been studied extensively. Both the peripheral and the central nervous systems are thought to be contributing to the origin of the pain in phantom limbs. You can easily spot the diagnosis if you read through the clinical note to specifically read the patient's complaints after surgery. Example, you may come across the clinical report of a chronic smoker who underwent amputation for a progressive gangrene in the left lower limb. You will read that the patient underwent a 'transtibial below-knee amputation on the left leg'. Two days following the surgical procedure, the patient complained that he felt there 'still persisted the leg' as he could feel the 'sharp penetrating pain' several times in a day. Your physician may prescribe tricyclic antidepressants or anticonvulsants or resort to one of the non-medical options like transcutaneous electrical nerve stimulation (TENS), vibration therapy or acupuncture.