Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that a patient suffers from “CRPS II.” I see codes for complex regional pain syndrome (CRPS) I, but I don’t see any for CRPS II. Am I missing something I should be seeing? How do I choose an ICD-10-CM code for CRPS II?

AAPC Forum Participant

Answer: Finding ICD-10-CM codes for CRPS II can be tricky if you don’t know where to look, as the codes for CRPS I and CRPS II are nowhere near each other in the ICD-10-CM code book. Also, CRPS II isn’t explicitly named in any ICD-10-CM code descriptor.

Here are two ways to find the correct diagnosis code:

• In the ICD-10-CM Alphabetic Index, look up Syndrome — pain (see also Pain), which directs you to complex regional II — see Causalgia (CRPS II and causalgia are used interchangeably for diagnosis coding purposes). When you look up Causalgia you get options for upper limb (G56.4- [Causalgia of upper limb]) and lower limb (G57.7- [Causalgia of lower limb]). Choose the most accurate ICD-10-CM code from these sets for your patient.
• Another way you could come across instructions for CRPS II coding is by looking at the CRPS I entry G90.5- (Complex regional pain syndrome I (CRPS I)). If you look in the code notes for G90.5-, you’ll see this entry:
  • “Excludes1: causalgia of lower limb (G57.7-)
  • “causalgia of upper limb (G56.4-)
  • “complex regional pain syndrome II of lower limb (G57.7-)
  • “complex regional pain syndrome II of upper limb (G56.4-).”

Chris Boucher, MS, CPC, Senior Development Editor, AAPC