Neurology & Pain Management Coding Alert

Question: What's the difference between 354.0 and 354.1? Carriers seem more likely to reimburse for 354.0.

Florida Subscriber

Answer: Codes 354.0 (Carpal tunnel syndrome) and 354.1 (Other lesion of median nerve) might have similar symptoms (such as tingling, numbness and pain in the thumb, index and middle fingers), but that doesn't mean you can interchange the diagnoses.

Primary difference: Carpal tunnel syndrome (354.0) happens when the transverse carpal ligament becomes inflamed. That inflammation compresses the nerve, causing a burning sensation or pain. Median nerve neuritis (354.1) is an inflammation of the nerve itself, not of surrounding tissue or ligaments.

Many times, physicians can treat carpal tunnel syndrome with braces or anti-inflammatory medications, but those treatments don't help median nerve neuritis.

Play by the rules: Whether you expect the carrier to

reimburse your claim or not, always submit the diagnosis and procedure codes that best represent the situation -- not just what you think will be paid.