Anesthesia Coding Alert

Question: Which diagnosis applies to sympathetically maintained pain? Is it the same as reflex sympathetic dystrophy?

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 nature of the condition 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).