Anesthesia Coding Alert

Documentation is the key to success  When a patient’s carpal tunnel syndrome (CTS) treatment stretches into extended care, don’t let carriers’ strict guidelines stop rightful reimbursement in its tracks. Train your providers to document medical necessity by carefully outlining the condition’s progressive nature.  Showing Full Diagnosis Starts You Off Right    ICD-9 only includes one CTS diagnosis: 354.0 (Carpal tunnel syndrome). Having only one code would seem to make your job easier, but carrier policies complicate your situation.

Roadblock: A stand-alone diagnosis of CTS doesn’t justify all forms of treatment in some carriers’ eyes. The ease of proving medical necessity depends partly on the service your physician provides.

“Usually, proving medical necessity of an injection is not as crucial as proving the medical necessity of more invasive surgical procedures,” says Myriam Nieves, CPC, ACS-PM, owner of the consulting firm Precision Medical Systems in Ft. Lauderdale, Fla.

Injection necessity: If your physician plans to administer a pain management injection to treat a patient’s CTS, carriers may require documentation that the patient has changed or avoided activities that cause the CTS symptoms, or that the patient needs to take frequent breaks from repetitive tasks.

Surgical proof: Before giving the go-ahead for open or endoscopic surgery to treat CTS, carriers might require documentation that NSAIDs, splints and physical therapy have failed or are not otherwise indicated. The carrier might also require proof of abnormal neuroelectrodiagnostic test results (such as electromyography [EMG] or nerve conduction studies).

Basic symptom coding: Common CTS symptoms include burning, tingling and numbness in the fingers (especially the median nerve distribution including the thumb, index and middle fingers), difficulty gripping or making a fist, an inability to hold objects, and wrist pain. Use codes such as 719.44 (Pain in joint; hand) and 782.0 (Disturbance of skin sensation), 728.87 (Muscle weakness [generalized]) and/or 719.43 (Pain in joint; forearm) to cover these patient symptoms. (Code 782.0 covers the burning, tingling and numbness patients often have.)

The signs and symptoms associated with CTS sometimes appear as a complication of other conditions. These might include:

• Reflex sympathetic dystrophy -- 337.20 (Reflex sympathetic dystrophy, unspecified) or 337.21 (Reflex sympathetic dystrophy of the upper limb)

• Trigger fingers -- 727.03 (Trigger finger [acquired])

• Nodules in the hands -- 782.2 (Localized superficial swelling, mass or lump)

• DeQuervain’s disease/syndrome -- 727.04 (Radial styloid tenosynovitis)

• Dupuytren’s contractures -- 728.6 (Contracture of palmar fascia). Inflammation caused by arthritis, pregnancy, obesity, hypothyroidism, repetitive motion disorder (RMD) and diabetes can also lead to CTS, [...]