Neurology & Pain Management Coding Alert

Question: What is the maximum number of tests a payer will allow to confirm a diagnosis of carpal tunnel syndrome (CTS)? Washington Subscriber Answer: Payers differ with regard to the maximum number of tests they will allow, but the American Association of Electrodiagnostic Medicine (AAEM) has created a comprehensive position statement regarding the optimal use of electrodiagnostic procedures for many indications, which most payers have adopted. According to the AAEM's Recommended Policy for Electrodiagnostic Medicine, a single electromyographic (EMG) study and a maximum of three motor nerve conduction studies (95900/95903) and four sensory nerve conduction studies (95904) are sufficient to confirm a diagnosis of unilateral CTS (354.0), while a diagnosis of bilateral CTS would require a maximum of two EMG studies, four motor NCS, and six sensory NCS. These are baseline values that apply to 90 percent of cases. In some instances, either fewer studies (when results of the most critical tests are normal) or more studies (in very complex cases or when findings are inconclusive) may be required. Note: For complete information on the AAEM's Recommended Policy for Electrodiagnostic Medicine, see the October 2002 Neurology Coding Alert or visit the AAEM Web site at www.aaem.net.