This is an update to the blog Coding Carpal Tunnel Syndrome (CTS) Using the Correct Medical Codes
One of the most common problems affecting the hand, carpal tunnel syndrome (CTS) occurs due to the compression of the median nerve. Located on the palm side of the hand in the wrist, the median nerve supplies the impulse to the muscle going to the thumb. Also called median nerve entrapment or median nerve compression, CTS can occur in one or both of the hands and usually affect the thumb, index finger and middle finger.
The compression of the median nerve causes symptoms including numbness, tingling, and weakness in the hand and arm. Administering a combination of treatment modalities like – wrist splinting, medications and surgery can help relieve the tingling and numbness and restore the wrist and hand function. Physicians administering treatment modalities for this condition must document the diagnosis and other related medical procedures with correct medical codes. Complete and accurate documentation, supported by efficient chiropractic billing services, can help providers communicate diagnosis, treatment, and results on claims for proper reimbursement.
The National Institute of Neurological Disorders and Stroke describes CTS as the “the most common and widely known of the entrapment neuropathies. Reports suggest that CTS affects 1-3 people per 1,000 in the United States every year. In most cases, people receive a diagnosis between the age group of 40 and 60 years and the prevalence increases with age. The condition is more common in females than in males. In most cases, there is no single cause of carpal tunnel syndrome. On the other hand, a combination of risk factors such as obesity, family history of CTS, nerve damaging conditions, working with vibrating tools, and strenuous/repetitive work with the hand – contributes to the development of the condition.
Common Symptoms of CTS
Generally, the signs and symptoms of CTS tend to develop gradually over time. Initially, the symptoms may appear at night or upon waking up in the morning and are found along the nerve path due to compression of the median nerve. The pain symptoms can range from mild to severe. In fact, as the intensity of the pain increases, it often becomes extremely difficult for a person even to hold a simple object or perform routine manual tasks. Some of the common symptoms include –
- Numbness, tingling, and pain in the thumb and the first three fingers of the hand
- Pain and burning that travels up the arm
- Wrist pain at night that interferes with sleep
- Dryness of the skin in the fingers and pain
- Weakness in the muscles of the hand
All these symptoms often tend to emerge or get worse after using the affected hand. The sensation of tingling, burning, and pain may worsen if the arm or hand has been in the same position for a long time.
How Is CTS Diagnosed and Treated?
Diagnosis of carpal tunnel syndrome involves a combination of physical examination, medical history review or symptoms, imaging tests and other nerve conduction tests. Physical examination involves a detailed evaluation of the hand, wrist, shoulder and neck to check for any other causes of nerve pressure. Physicians will check the wrists to look for signs of tenderness, swelling and other related deformities. They will also check sensation in the fingers and strength of the muscles in the hand. Imaging tests like X-Ray, Ultrasound and Electromyography may be performed to identify the causes of wrist pain. Nerve conduction studies are performed to measure the conduction speed of the nerve impulses and rule out other conditions. If the nerve impulse is slower than normal as the nerve passes into the hand, the patient may have carpal tunnel syndrome.
Treatment for carpal tunnel syndrome depends on the severity and intensity of the symptoms. It is best to treat the symptoms of carpal tunnel syndrome as early as possible soon after the symptoms start. Incorporating or doing simple things like – taking more-frequent breaks to rest the hands, applying cold packs to reduce the swelling and avoiding activities (that make symptoms worse) may be advised. Other non-surgical therapies include – wrist splinting, medications (Non-steroidal anti-inflammatory drugs and Corticosteroids) and surgery. Splinting and other conservative treatments are more likely to help if a person experiences only mild to moderate symptoms that come and go for less than 10 months. On the other hand, if the symptoms become severe or don’t respond to other treatment modalities, surgery may be performed to relieve pressure by cutting the ligament pressing on the median nerve. Common surgical methods include – endoscopic surgery and open surgery.
Medical Codes to Report Carpal Tunnel Syndrome
Chiropractic medical coding involves the use of specific ICD-10 codes and CPT codes to document different pain conditions, including carpal tunnel syndrome.
ICD-10 Codes
- G56.0 Carpal tunnel syndrome
- G56.00 …… unspecified upper limb
- G56.01 …… right upper limb
- G56.02 …… left upper limb
- G56.03 …… bilateral upper limbs
- G56.1 Other lesions of median nerve
- G56.10 …… unspecified upper limb
- G56.11 …… right upper limb
- G56.12 …… left upper limb
- G56.13 …… bilateral upper limbs
CPT Codes
- 20526 – Injection, therapeutic; carpal tunnel
- 29848 – Endoscopic carpal tunnel release
- 64721 – Neuroplasty and/or transposition; median nerve at carpal tunnel
- 64708 – Neuroplasty, major peripheral nerve, arm or leg; other than specified
Treating carpal tunnel syndrome at an early stage with physical therapy and lifestyle changes can help eliminate symptoms and lead to significant long-term improvement. Treating conditions like diabetes, high blood pressure, and arthritis reduces the risk for developing carpal tunnel syndrome. Avoiding activities that overextend the wrist and paying careful attention to hand posture and related movements can help minimize the symptoms of CTS in the long run.
Billing and coding for various chiropractic conditions can be challenging. For accurate and timely medical billing and claims submission, chiropractic practices can outsource their medical coding tasks to established medical billing companies that provide the services of AAPC-certified coding specialists who are up-to-date with the latest codes, billing guidelines, and payer reimbursement policies.
Since joining our RCM Division in October 2021, Loralee, who is HIT Certified (Health Information Technology/Health Information Management), brings her extensive expertise in medical coding and Health Information Management practices to OSI.