Central sensitisation syndrome (CSS)

Created Sep 2022

Query

What ICD-10-AM code is assigned for ‘flare of central sensitisation syndrome”?

Case summary: A patient was admitted to hospital for a flare-up of widespread chronic pain, especially in both lower legs and abdomen. In 2021 the patient had multiple admissions to hospital due to central sensitisation syndrome with severe pain.

A web search states: “Central sensitisation syndromes (CSS) are a collection of disorders where the central nervous system misfires and amplifies sensory input resulting in pain, fatigue, brain fog, and sleep problems. Fibromyalgia (FMS), chronic fatigue syndrome (ME/CFS), and other chronic pain conditions fall under the CSS umbrella.” – Central Pain Syndrome – NORD Rare Disease Database

Response

Based on research ‘central sensitisation syndrome’ is also known as ‘central pain syndrome’. The disorder develops following damage to the central nervous system – the brain, brainstem or spinal cord. Such damage is most often associated with a stroke, multiple sclerosis, spinal cord (but also brain) injury or brain tumours. Central pain syndrome can also develop after neurosurgical procedures involving the brain or spine. – Central Pain Syndrome – NORD Rare Disease Database

For clinical documentation of ‘central sensitisation syndrome’ assign G96.8 Other specified disorders of central nervous system following the ICD-10-AM Alphabetic Index Disorder/nervous system/central/specified NEC G96.8 and assign R52.2 Chronic pain as per ACS 1807 Acute on chronic pain where there is also clinical documentation of chronic pain. Please use free text on code G96.8 to specify ‘central sensitisation syndrome’.

The code U91 Syndrome not elsewhere classified is not assigned as ACS 0005 Syndromes states where a syndrome is classified to a single ICD-10-AM code U91 Syndrome not elsewhere classified is not assigned.

A coding query has been raised with the Independent Health and Aged Care Pricing Authority (IHACPA) to confirm code assignment.

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