Inpatient Facility Coding & Compliance Alert

Focus on the change in name and added laterality. 

One of the most important parts of ICD-10 transition preparation is ensuring you’ve planned ahead to get the specific documentation you need to choose the most appropriate code. 

“ICD-10 requires greater specificity in coding in almost every area. Reference books that cross-walk the ICD-9 to the various ICD-10 codes illustrate the need for greater specificity,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA.

For cervical region disorders, that means making it simple for your physician to capture the nature of the disorder based on ICD-10 categories. Here are the areas to watch for the reflex sympathetic dystrophy disorders.

Reflex sympathetic dystrophy (RSD) is a condition that one does see in inpatients, particularly in the Inpatient Rehabilitation Facility (IRFs).

ICD-9 gives four options to choose from for a diagnosis RSD, based on the affected site. When ICD-10 becomes effective in October 2015, you’ll have more specific site choices to report as well as a switch to updated terminology.

ICD-9 coding: Diagnoses for RSD belong to the 337.2x code family, with the fifth digit noting the anatomic site. They are:

• 337.20 – Reflex sympathetic dystrophy, unspecified
  
• 337.21 – Reflex sympathetic dystrophy of the upper limb
  
• 337.22 – Reflex sympathetic dystrophy of the lower limb
  
• 337.29 – Reflex sympathetic dystrophy of other specified site. This could include non-extremity sites such as the chest, breast, or abdomen. 
  

ICD-10 differences: Your providers will need to be more specific in their documentation once you begin coding under ICD-10. Notes of “upper” or “lower” won’t be enough to pinpoint the best code at that point – you’ll also need to know “right,” “left,” or “bilateral.” The new range of choices will be: 

• G90.50 – Complex regional pain syndrome I, unspecified 
  
• G90.511 – Complex regional pain syndrome I of right upper limb
  
• G90.512 – Complex regional pain syndrome I of left upper limb
  
• G90.513 – Complex regional pain syndrome I of upper limb, bilateral
  
• G90.521 – Complex regional pain syndrome I of right lower limb
  
• G90.522 – Complex regional pain syndrome I of left lower limb
  
• G90.523 – Complex regional pain syndrome I of lower limb, bilateral.
  

Note that ICD-10 also lists the condition under its other name: complex regional pain syndrome, or CRPS. CRPS Type I is the current worldwide term replacing the old name of RSD. CRPS Type II represents causalgia which is severe pain typically associated with a nerve injury.