Neurology & Pain Management Coding Alert

Question: What diagnosis applies to sympathetically maintained pain? Is it the same as RSD? North Dakota Subscriber Answer: Yes, sympathetically maintained pain (SMP) and reflex sympathetic dystrophy (RSD) are the same condition. But there's a third term you need to know: complex regional pain syndrome (CRPS). In 1995, the medical community changed the name RSD to CRPS to better reflect the condition's nature and to establish a universal term for research purposes. Most physicians use the term -CRPS,- but patients and families still use the familiar term -RSD.- ICD-9, however, does not include a listing for CRPS. Instead, you find several diagnoses for RSD under -Dystrophy, sympathetic- (337.2x, Reflex sympathetic dystrophy). Narrow your choice to the best-fitting fifth digit that describes the site. Further distinction: CRPS is classified as two types. Type I is used interchangeably with RSD, which means you can compliantly report the 337.2x codes for CRPS type I diagnoses. CRPS type II is also known as causalgia and represents when the physician can trace the patient's pain to an identifiable nerve injury (CRPS type I has similar symptoms but no identifiable nerve injury). Report causalgia (CRPS type II) with 354.4 (Causalgia of upper limb), 355.71 (Causalgia of lower limb) or 355.9 (Causalgia NOS).