Don't Tip Your Hand Too Early For Carpal Tunnel
Published on Fri Sep 22, 2006
Find out when you should and shouldn't use 354.0
When you-re reporting carpal tunnel syndrome, you shouldn't always report 354.0 up-front. Follow our coding guidelines to ensure proper reimbursement, even if testing doesn't establish a definitive diagnosis. Rely on the Signs Even when a physician suspects that a patient has carpal tunnel syndrome (354.0), if you use that code before he completes all testing, you could limit your future range of billable tests.
In other words, until testing confirms the carpal tunnel diagnosis, you should depend on symptoms to justify any services the physician provides. Typical signs and symptoms indicative of carpal tunnel syndrome include numbness and tingling (782.0); aching pain in the thumb, index, and middle fingers that may move up the arm (729.5); hand and grip muscle weakness (728.87); and feeling of swollen hand (729.81). Beware of Results That Are Inconclusive, Negative Caution: If the neurologist conducts the appropriate testing but the results are inconclusive or negative for carpal tunnel syndrome, you should rely only on the signs and symptoms to establish medical necessity for the tests the neurologist conducts, as well as any E/M service he provides. But make sure your physician's documentation is strong enough to support the claim, regardless of the outcome of diagnostic testing.
Although your neurologist may suspect carpal tunnel, -CTS is not the only disease process that can cause symptoms generally associated with CTS,- says Rena Hall, CPC, billing/insurance coordinator at Kansas City Neurosurgery Group in Missouri. If you do have a conclusive diagnosis, however, you should use it.
Example: The neurologist conducts electrodiagnostic testing (such as nerve conduction studies, 95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study; and/or electromyography, 95860, Needle electromyography; one extremity with or without related paraspinal areas) and confirms a diagnosis of carpal tunnel syndrome. In this case, you should report 354.0 as the primary diagnosis. Remember ICD Guidelines Note: Another standard study for CTS is 95904 (Nerve conduction, amplitude and latency/velocity study, each nerve; sensory). If your physician provides this service and diagnoses CTS (354.0), you do not need to report signs and symptoms as secondary diagnoses. The reason is that these diagnoses are integral to arriving at the primary diagnosis. ICD-9 guidelines state: -Signs and symptoms that are integral to a disease process should not be assigned as additional codes.-
Rule of thumb: You should only report signs and systems if your provider didn't confirm CTS, or if the patient had additional signs and symptoms not integral to CTS. Watch Limbs Versus Units With EMGs, NCSs Make sure you-re not mixing up the rules for reporting an electromyogram (EMG) and a nerve conduction study (NCS).
EMG key: When you code an EMG that your neurologist performs [...]
