Pain Management Coding Alert

Question: What diagnosis code should we report for CRPS of the chest wall?

Texas Subscriber

Answer: If your provider’s documentation clearly mentions CRPS type I (complex regional pain syndrome) of the chest wall, ICD-9 code 337.29 (Reflex sympathetic dystrophy of other specified sites) is most appropriate diagnosis. The ICD-10 crosswalk code will be G90.59 (Complex regional pain syndrome I of other specified site).

One of the primary signs/symptoms of CRPS includes a burning and/or pins and needles type pain. Until your physician confirms the CRPS diagnosis, many coders currently report 782.0 (Disturbance of skin sensation) along with the corresponding pain code. Note that 782.0 includes conditions your provider might describe as “anesthesia of skin,” “burning or prickling sensation,” “hyperesthesia,” “hypoesthesia,” “numbness,” “paresthesia,” or “tingling.”

Upcoming change: In ICD-10, diagnosis 782.0 expands to several codes that address these same individual signs and symptoms:

• R20.0 – Anesthesia of skin

• R20.1 – Hypoesthesia of skin

• R20.2 – Paresthesia of skin

• R20.3 – Hyperesthesia

• R20.8 – Other disturbances of skin sensation

• R20.9 – Unspecified disturbances of skin sensation.

If the documentation does not specify type I CRPS, you should probably report 786.52 (Painful respiration). Note that the code includes anterior chest wall pain, pleuritic pain, and pleurodynia. When you begin using ICD-10 in October, you’ll switch to either diagnosis code R07.1 (Chest pain on breathing) or R07.81 (Pleurodynia).

CRPS is a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb. Scientists believe CRPS is caused by damage to, or malfunction of, the peripheral and central nervous systems.