G54.6
BillablePhantom limb syndrome with pain
HCC Category Mapping
V28HCC 409 — Amputation Status, Lower Limb/Amputation Complications
0.350V24HCC 189 — Amputation Status, Lower Limb/Amputation Complications
0.350ESRDHCC 189 — Amputation Status, Lower Limb/Amputation Complications
0.000What This Code Means
Persistent pain felt in a limb that has been amputated or lost, where the patient feels sensations as if the missing limb is still present.
Coding Tips
- •Specify which limb is affected and laterality
- •Document whether pain is the primary complaint versus other phantom sensations
Clinical Significance
Phantom limb syndrome with pain is a complex neuropathic condition where patients experience painful sensations perceived as coming from an amputated or missing limb. This condition affects 50-80% of amputees and significantly impacts rehabilitation, prosthetic use, and quality of life. It maps to CMS-HCC V28 category 409 and V24 category 189, both carrying a RAF weight of 0.350, making it a significant risk adjustment diagnosis.
Documentation Requirements
- ✓History of limb amputation or congenital limb absence documented
- ✓Description of phantom pain: type (burning, shooting, cramping, crushing), location within phantom limb, intensity
- ✓Pain frequency and duration (episodic vs. constant)
- ✓Distinction from residual limb (stump) pain which is a different condition
- ✓Functional impact: effect on prosthetic use, sleep, rehabilitation participation
- ✓Current pain management regimen (medications, mirror therapy, TENS, nerve blocks)
- ✓Assessment of pain severity using validated scale
Commonly Confused Codes
G54.7 (Phantom limb syndrome without pain) — phantom sensations present but not painful; different code and clinical managementG54.4 (Lumbosacral root disorders) — nerve root pathology, not phantom limb phenomenonT87.30-T87.9 (Complications of reattached extremity/amputation stump) — stump complications are distinct from phantom limbG89.4 (Chronic pain syndrome) — general chronic pain; phantom limb pain has a specific codeM79.60x (Pain in limb) — use for pain in an existing limb, not a phantom limb
Code Hierarchy
└G54Nerve root and plexus disorders└G54.6Phantom limb syndrome with pain
└G54.6Phantom limb syndrome with pain