Neurology & Pain Management Coding Alert

Question: What is the proper diagnosis code for "complex regional pain syndrome"? I am unable to find anything in the ICD-9 manual. Michigan Subscriber Answer: The appropriate diagnosis for complex regional pain syndrome (CRPS) depends on whether the neurologist can detect nerve injury as the cause of the patient's symptoms, as well as the location of those symptoms. CRPS is a chronic condition believed to result from a dysfunction in the central or peripheral nervous systems. Symptoms can include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating and swelling. Type I CRPS usually results from tissue injury and describes patients with the above symptoms but no detectable underlying nerve damage. The appropriate ICD-9 code for this condition is 337.2x (Reflex sympathetic dystrophy). You must supply a fifth-digit with this diagnosis to indicate location, e.g., 337.21, ... of the upper limb. Patients with Type II CRPS display the same symptoms as patients with Type I CRPS, but the neurologist can clearly establish a link between the Type II patients'symptoms and nerve injury. Report these diagnoses using the codes that describe causalgia:

354.4 -- Causalgia of upper limb
355.71 -- Causalgia of lower limb
355.9 -- ... unspecified site. -- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.