The American
Association of Neuromuscular & Electrodiagnostic Medicine (AANEM [formerly
AAEM]) is concerned about a recent policy trend where some insurance companies
maintain that all carpal tunnel syndrome (CTS)-related services are to
be billed to Workers’ Compensation, regardless of the individual
patient’s situation. It is the AANEM’s position that this policy
is inappropriate. CTS is one of the more common reasons that a patient
is referred for an electrodiagnostic medicine consultation. CTS is a non-specific
diagnosis defined by a constellation of signs and symptoms, which indicates
nothing about the underlying cause.
The presenting symptoms, which often include hand/wrist
pain, numbness in the fingers, and weakness/clumsiness, can be present
in conditions other than CTS. This is one of the main reasons for the
performance of electrodiagnostic testing. The differential diagnosis of
these symptoms includes cervical radiculopathy, tendonitis of the wrist,
peripheral neuropathy, and myofascial pain syndromes. The underlying causes
of CTS are not limited to repetitive motion or work-related cumulative
trauma. A vast amount of scientific literature documents multiple nonwork-related
causes of CTS, which include pregnancy, obesity, diabetes mellitus, blunt
trauma to the wrist, infectious diseases, and others. In one study published
in the Mayo Clinic Proceedings in June of 1992, there was no underlying
cause for CTS in 43.2% of over 1000 patients. In the remaining 56.8% of
patients, the causes of CTS varied from rheumatoid arthritis, to use of
hormonal agents, to occupations that involve repetitive hand motions.
It is the position
of AANEM that the determination of the underlying cause of CTS (work versus
nonwork-related) be left to the physician. This would allow a full evaluation
of the medical documentation to determine eligibility for payment. The
AANEM does not believe that Worker’s Compensation should be billed
for studies performed to diagnose or treat CTS when the cause of the problem
is not work-related.
Approved
by the American Association of Neuromuscular & Electrodiagnostic Medicine
(formerly AAEM): April 1999.
