Anesthesia Coding Alert

Question: Encounter notes indicate that the provider performed a service for a patient with “CRPS 1, arm.” Which diagnosis code applies?

Arkansas Subscriber

Answer: Based on the information provided, the correct ICD-10-CM code is G90.519 (Complex regional pain syndrome I of unspecified upper limb).

Here’s why: Your notes indicate complex regional pain syndrome 1 (CRPS I), which leads you to subcategory G90.51- (Complex regional pain syndrome I of upper limb). This subcategory requires an additional character to be complete, and the “unspecified upper limb” code is appropriate when the provider doesn’t specify the arm involved.

Do this: Go back and check the notes to see if the provider indicated laterality for the CRPS. Then, you can choose one of these more specific ICD-10-CM codes:

• G90.511 (… right upper limb)
• G90.512 (… left upper limb)
• G90.513 (… bilateral)

Helpful: Reflex sympathetic dystrophy is a synonym you may see for CRPS I, according to a note with G90.5- (Complex regional pain syndrome I (CRPS I)) in ICD-10-CM.

Caution: If the comma had been missing so that the documentation showed “CRPS 1 arm,” you would need to clarify the diagnosis with the provider because the “1” could refer to one arm. While CRPS I falls under G90.51-, there is also CRPS II, which is coded to G56.4- (Causalgia of upper limb).