Optimize Reimbursement For Carpal Tunnel Syndrome
Published on Sat Jan 01, 2000
Neurologists who diagnose and treat carpal tunnel syndrome (354.0) often face difficulties obtaining appropriate reimbursement for their services because of the image carpal tunnel syndrome (CTS) has in the insurance community, the variety of ways to diagnose and treat CTS, and the bilateral billing issues that arise when carpal tunnel is diagnosed in both hands. But through thorough documentation and proper code choices, physicians can ensure correct billing and payment.
Daniel Hemker, a neurology coding specialist for Advantage Billing Service, a third-party biller in Tinley Park, Ill., says that many carriers still view carpal tunnel the way they might certain generic diagnoses such as back pain or neck pain. Carriers sometimes think theyre being scammed if you bill for it, Hemker reports. Full documentation is one of the keys to avoiding difficulties.
To say that a patients fingers hurt is not enough, Hemker adds. The neurologist needs to have detailed documentation of the presenting problem and all related symptoms, such as limited range of motion, and what the neurologist did to combat the syndrome.
Hemker explains that the carpal tunnel is a narrow passageway in the wrist that contains and protects the nerves and tendons extending into the hand. When the tissues in the carpal tunnel become swollen or inflamed, they put pressure on the median nerve, which provides sensation to the thumb, index, middle, and ring fingers. Excess pressure on this nerve produces the numbness and pain that characterize CTS. This problem may affect both wrists.
Identifying and Monitoring CTS
For example, a patient presents complaining of numbness and tingling in her wrists. She tells the neurologist that the symptoms get worse at night. The neurologist suspects that CTS may be present and asks the patient if the numbness is in every finger of her hand except the little finger (generally an indicator of CTS). The patient confirms that this is the case.
The neurologist performs a test for Tinels sign, which most carriers feel is a reliable indication that CTS is present. Atrophy or loss of bulk in the muscle of the thumb also may be an indicator. X-rays also can be performed.
The neurologist also may want to perform an electromyogram (EMG) (95860, needle EMG, one extremity with or without paraspinal areas; or 95861, needle EMG, two extremities with or without paraspinal areas) and a nerve conduction study (95900, nerve conduction, amplitude and latency/velocity study, each nerve; motor without F-wave study; 95903, nerve conduction, amplitude and latency/velocity study, each nerve; motor with F-wave study; or 95904, nerve conduction, amplitude and latency/velocity study, each nerve; sensory or mixed).
The neurologist must show medical necessity if he or she decides to perform an electromyogram or a nerve conduction [...]
