Electrodiagnostic studies — electromyography and nerve ... · electromyography (NEMG), to be clinically proven and, ... Several new technologies entered the market over the past

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Clinical Policy Title: Electrodiagnostic studies — electromyography and nerve

conduction studies

Clinical Policy Number: 09.01.04

Effective Date: June 1, 2014

Initial Review Date: January 15, 2014

Most Recent Review Date: March 15, 2017

Next Review Date: March 2018

Related policies:

None.

ABOUT THIS POLICY: AmeriHealth Caritas has developed clinical policies to assist with making coverage determinations. AmeriHealth Caritas’

clinical policies are based on guidelines from established industry sources, such as the Centers for Medicare & Medicaid Services (CMS), state regulatory agencies, the American Medical Association (AMA), medical specialty professional societies, and peer-reviewed professional literature. These clinical policies along with other sources, such as plan benefits and state and federal laws and regulatory requirements, including any state- or plan-specific definition of “medically necessary,” and the specific facts of the particular situation are considered by AmeriHealth Caritas when making coverage determinations. In the event of conflict between this clinical policy and plan benefits and/or state or federal laws and/or regulatory requirements, the plan benefits and/or state and federal laws and/or regulatory requirements shall control. AmeriHealth Caritas’ clinical policies are for informational purposes only and not intended as medical advice or to direct treatment. Physicians and other health care providers are solely responsible for the treatment decisions for their patients. AmeriHealth Caritas’ clinical policies are reflective of evidence-based medicine at the time of review. As medical science evolves, AmeriHealth Caritas will update its clinical policies as necessary. AmeriHealth Caritas’ clinical policies are not guarantees of payment.

Coverage policy

AmeriHealth Caritas considers the use of nerve conduction studies (NCSs), when paired with needle

electromyography (NEMG), to be clinically proven and, therefore, medically necessary when the

following criteria are met:

Must be performed by a primary care provider (PCP) properly trained in the fields of

neurology and/or physiatry, or a PCP who has specific training and expertise in

electrophysiologic studies.

Must be performed for an appropriate diagnosis as listed by the American Association of

Neuromuscular and Electrodiagnostic Medicine (AANEM) (see attached codes).

Limitations:

AmeriHealth Caritas considers the use of the electrodiagnostic tools listed below to be

investigational/experimental and, therefore, not medically necessary:

Policy contains:

Needle electromyography (NEMG).

Surface electromyography (SEMG).

Nerve conduction study (NCS).

NC-stat® System.

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When an NCS is performed in the absence of an NEMG.

When none of the diagnoses listed by the AANEM are included on the claim.

When non-standard diagnostic modalities, such as surface electromyography (SEMG), the

NC-stat® System, quantitative sensory testing (QST) for lower extremity peripheral

neuropathy, NeuroQuick, Neuropad®, or the NK Pressure-Specified Sensory Device™, are

employed.

* Refer to InterQual for medical review and decision tree.

All other uses of electrodiagnostic modalities, electromyography (EMG), and NCSs are not medically

necessary.

Alternative covered services:

NEMGs.

Needle (near-placed) nerve conduction velocity (NCV) tests.

Imaging studies.

PCP office visits.

Background

Diagnosis of neuromuscular disorders is often difficult. Conditions impacting the peripheral nervous

system (PNS), muscles, motor cells of the spinal cord, or the neuromuscular junctions may have similar

presentations. The conditions within this spectrum may range from amyotrophic lateral sclerosis (ALS),

carpal tunnel syndrome, multiple sclerosis (MS), myasthenia gravis (MG), myotonic spinal muscular

atrophy (SMA), and other conditions. After a history is taken and a physical examination performed, the

evaluating professionals may require further diagnostic modalities in the evaluation of neuromuscular

disorders, which may include:

NCSs.

NEMGs.

Autonomic reflex testing.

Cardiovascular autonomic testing.

Muscle and/or nerve biopsies.

EMG and nerve conduction velocity (NCV) are commonly performed tests for neuromuscular disorders.

In past decades, both were considered standards. However, both tests require needle insertion, which

can be uncomfortable for many patients. In most states, the insertion of needles can only be performed

by physicians or other PCPs with licenses that include this scope of practice. Newer technologies use

surface methods to assess nerve and muscle performance, which allow for greater patient comfort and

the ability of providers who are not licensed to insert needles to perform these non-invasive, surface

tests.

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During an SEMG, in lieu of needles, surface electrodes are placed on the overlying affected muscles.

Although the technique is less invasive, SEMGs have a lower signal resolution and are subject to greater

muscle movement artifact. While SEMGs may improve amplitude, studies do not demonstrate SEMGs to

be superior to, or even equal to, the diagnostic capabilities of NEMGs. In 2000, the American Academy

of Neurology (AAN) found SEMGs unacceptable for diagnosing neuromuscular disease and low back

pain, but acceptable for kinesiology analysis of movement disorders; for differentiating types of tremors,

myoclonus, and dystonia; for evaluating gait and posture disturbances; and for evaluating

psychophysical measures of reaction and movement time (Pullman, 2000).

A subsequent meta-analysis of the literature concluded that the technology was of possible assistance in

diagnosis of neuromuscular diseases, fatigue associated with post-polio syndrome, and

electromechanical function in myotonic dystrophy. There is insufficient data to support the use of SEMG

in distinguishing between neuropathic and myopathic conditions, or for the diagnosis of specific

neuromuscular diseases (Meekins, 2008).

In 2009, the International Chiropractors Association developed consensus-based guidelines, which

indicated the use of SEMG may be helpful in the evaluation of cervical spine pain, trapezius pain, and

low back disorders in patients with a whiplash injury. This guideline did not provide any strength-of-

evidence statements, but represented the opinion of the authors (ICA, 2009).

NCSs, also termed NCV studies, are used in assessing the health of peripheral nerves. NCS measures the

patient’s response to electrical stimulation, applied via a surface electrode. Sensory function is

measured through another surface electrode, which is placed over the skin in the distribution area of

the peripheral nerve being tested. The motor responses are measured by the muscle’s response, as

detected by an electrode placed over the muscle with the innervation in question. Nerve conduction

studies assess the speed (i.e., conduction velocity or latency), size or amplitude, and shape of the

patient’s response to the electrical stimulation.

Common symptoms Diagnosis

Generalized weakness Neuropathies.

Myopathies (including endocrine).

Motor system disease (e.g., ALS).

Neuromuscular junction disorder (e.g., MG).

Facial weakness (including ptosis) Facial (seventh cranial) nerve lesions.

Myopathy.

Neuromuscular junction disorder (e.g., MG).

Facial pain and/or numbness; involuntary facial movement Injury of the trigeminal (fifth cranial) nerve.

Myokymia.

Hemifacial spasm.

Dysphagia

Myopathy.

Neuromuscular junction disorder (e.g., MG).

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Dysarthria

Motor system disease (e.g., ALS).

Respiratory insufficiency Injury of the hypoglossal (12th cranial) nerve.

Neuromuscular junction disorder (e.g., MG).

Motor system disease (e.g., ALS).

Neck pain Phrenic nerve lesions.

Myopathy (e.g., acid maltese deficiency).

MG.

Motor system disease (e.g., ALS).

Cervical radiculopathy.

Thoracic pain Back pain

Brachial plexopathy.

Focal neuropathy (e.g., spinal accessory nerve).

Shoulder and arm pain, numbness, altered sensation (e.g., pins and needles), weakness, cramps, fasciculations, muscle atrophy, or hypertrophy (focal or diffuse) Hip and leg pain, numbness, altered sensation (i.e., pins and needles), weakness, cramps, fasciculations, muscle atrophy, or hypertrophy

Thoracic radiculopathy.

Lumbosacral radiculopathy.

Lumbosacral plexopathy.

Cervical radiculopathy.

Brachial plexopathy.

Polyneuropathy.

Focal neuropathy (e.g., carpal tunnel syndrome, ulnar nerve injury at the elbow, suprascapular nerve injury at the shoulder).

Myopathy.

Motor system disease (e.g., ALS).

Syrinx.

Urinary and anal sphincter dysfunction Lumbosacral radiculopathy.

Lumbosacral plexopathy.

Polyneuropathy.

Focal neuropathy (e.g., tarsal tunnel syndrome, femoral [focal or diffuse] mononeuropathy).

Myopathy.

Motor system disease (e.g., ALS).

Distal weakness Lumbosacral radiculopathy.

Cauda equina syndrome.

Perineal neuropathy.

Lumbar stenosis.

Polyradiculopathy.

Pudendal nerve injury.

Diffuse lumbosacral root injury.

Proximal weakness Polyneuropathy.

Focal mononeuropathy (e.g., carpal tunnel syndrome, ulnar neuropathy).

Myopathy (e.g., inclusion body myositis, distal myopathy).

Myopathy.

Plexopathy.

From Referral Guidelines for Electrodiagnostic Medicine Consultations

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Approved by the AAEM: August 1996. https://www.aanem.org/getmedia/06d8728f-ba17-4fee-83d4-580a2c2df924/referral-_gl.PDF.aspx. Last accessed February 7, 2017.

Several new technologies entered the market over the past decade. Their goals were to duplicate the

results of NEMGs and NCSs and make electrodiagnostics easier. However, there are no sufficient studies

to demonstrate their equivalency in real-world settings. For this reason, tests such as QST for diagnosis

of lower extremity peripheral neuropathy, NC-stat System, and NK Pressure-Specified Sensory Device

remain the standard electrodiagnostic tests.

Searches

AmeriHealth Caritas searched PubMed and the databases of:

UK National Health Services Centre for Reviews and Dissemination.

Agency for Healthcare Research and Quality’s National Guideline Clearinghouse and other

evidence-based practice centers.

The Centers for Medicare & Medicaid Services (CMS).

We conducted searches on February 7, 2017. Search terms were: “nerve conduction studies,”

“electromyography,” and “electrodiagnostic studies.”

We included:

Systematic reviews, which pool results from multiple studies to achieve larger sample sizes

and greater precision of effect estimation than in smaller primary studies. Systematic

reviews use predetermined transparent methods to minimize bias, effectively treating the

review as a scientific endeavor, and are thus rated highest in evidence-grading hierarchies.

Guidelines based on systematic reviews.

Economic analyses, such as cost-effectiveness, and benefit or utility studies (but not simple

cost studies), reporting both costs and outcomes — sometimes referred to as efficiency

studies — which also rank near the top of evidence hierarchies.

Findings

Electrodiagnostic evaluation is an extension of the neuromuscular portion of the physical exam,

performed almost exclusively by neurologists or physiatrists. The exam typically includes a needle EMG

and nerve conduction study (NCS). The number of EMG and NCS exams needed are matters of clinical

judgment, and the complexity/extent of testing can change during the testing procedure.

The suggested maximum number of tests is designed to apply to a certain number of practice styles and

types; sometimes more tests may be necessary. In complex cases, the maximum number of tests may be

insufficient to arrive at a complete diagnosis (AANEM, 2010).

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Limbs studied by EMG Nerve conduction studies

Indication Number of services/tests Number of services/tests

Carpal tunnel (unilateral) 1 7

Carpal tunnel (bilateral) 2 10

Radiculopathy 2 7

Mononeuropathy 1 8

Polyneuropathy/mononeuropathy multiplex 3 10

Myopathy 2 4

Motor neuropathy (e.g., ALS) 4 6

Plexopathy 2 12

Neuromuscular junction 2 2

Tarsal tunnel syndrome (unilateral) 1 8

Tarsal tunnel syndrome (bilateral) 2 11

Weakness, fatigue, cramps, twitching (focal) 2 7

Weakness, fatigue, cramps, twitching

(general)

4 8

Pain, numbness, or tingling (unilateral) 1 9

Pain, numbness, or tingling (bilateral) 2 12

Some guidelines specific to a particular disease address use of EMG and NCV tests. For example, the

American Academy of Orthopedic Surgeons 2009 guideline on diagnosing carpal tunnel syndrome

indicated that physicians may order electrodiagnostic tests when clinical tests are positive and surgery is

being considered. Protocols should follow the joint guideline from the American Academy of Neurology,

American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of

Physical Medicine and Rehabilitation (Keith, 2009).

The published literature contains a very modest amount of studies on EMG/NCS efficacy. EMG and NCS

generally produce accurate results, but there are potential technical problems that may interfere with

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accurate and reliable acquisition of information, which in turn affects data interpretation. They are also

safe procedures; only in rare instances do risks and complications occur (Rubin, 2012).

Automated hand-held NCS devices have recently been introduced into medical practice. One review

compared 50 patients referred to a tertiary referral EMG lab for testing unilateral leg weakness, sensory

complaints, or pain undergoing automated NCS and standard electrodiagnostic study with 25 healthy

controls also undergoing the same tests. Raw data were comparable using both techniques, but

computer-generated data were found to have high sensitivity and low specificity, i.e., many false

positives.

Another study of automated nerve conduction study reliability compared this diagnostic tool with the

traditional device in 62 patients. Motor and sensory latency results had a high level of agreement

between the two methods (correlation coefficients 0.80 and 0.85). Both types of latency had a

sensitivity of 100 percent, and specificity was 87 and 86 percent, respectively. Ulnar nerve testing results

were not as favorable (Dale, 2015).

A meta-analysis of five studies (n=448) of persons with symptomatic hands being tested using NCS for

median neuropathy in carpal tunnel syndrome found high sensitivity and specificity, i.e., 88 and 93

percent (Strickland, 2011). In a systematic review of 24 studies addressing diagnosis of spinal stenosis,

electrodiagnostic studies were similar in accuracy to magnetic resource imaging (de Schepper et al,

2013). Other applications of EMG fail to demonstrate accuracy. A systematic review/meta-analysis of 11

studies addressing EMG to prevent misplacement of pedicle screws in the lumbar and thoracic spine

found sensitivity (55 and 41 percent) to be low and specificity (97 and 95 percent) to be high (Lee, 2015).

Electrodiagnostic studies can also be used as an adjunct for other tests; one example occurs when

advanced imaging does not reveal a conclusive source of pathology for patients with shoulder and

cervical spine pain (Bokshen, 2016).

Policy updates:

A total of one practice guideline/other and six peer-reviewed references were added to this version of

the policy. A total of three guidelines/other and eight peer-reviewed references were removed, as they

are at least a decade old.

Summary of clinical evidence:

Citation Content, Methods, Recommendations

Lee (2015) Assessment of diagnostic value of EMG for pedicle screw placement

Key points:

Systematic review/meta-analysis of 11 studies.

Total of 13,948 and 2,070 lumbar and thoracic screws.

Sensitivity for lumbar and thoracic screws was 55 and 41 percent.

Specificity for lumbar and thoracic screws was 97 and 95 percent.

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Rubin (2012) Paper is a review of the technical issues with electrodiagnostic studies of NCS and EMG

Key points:

Potential technical problems encountered during studies may interfere with accurate and reliable acquisition of information. These are discussed in this paper.

Strickland (2011) Accuracy of nerve conduction studies for median neuropathy

Key points:

Meta-analysis of five reports (n=448), in-office nerve conduction studies.

Subjects had symptomatic hands; focus on median neuropathy (median nerve conduction across the wrist).

Sensitivity and specificity were 88 and 92 percent.

Meekins, AANEM (2008) Review of past guidelines and current literature to date of article

Key points:

SEMG measures myoelectric signals recorded from sensors placed on the skin surface, making this a potentially useful technology.

Concluded that SEMG adds no clinical utility over NEMG for diagnosis of neuromuscular disease.

Additional data is at a level C (class III data) for distinguishing between neuropathic and myopathic conditions, or for fatigue associated with post-polio syndrome.

References

Professional society guidelines/other:

American Association of Neuromuscular & Electrodiagnostic Medicine. Model policy for needle

electromyography and nerve conduction studies. AANEM, 2010, updated and re-approved 2016.

https://www.aanem.org/getmedia/65934187-d91e-4336-9f3c-50522449e565/Model-Policy.pdf.

Accessed February 7, 2017.

Criswell E, ed. Cram's Introduction to Surface Electromyography, Second Edition. Sudbury MA: Jones and

Bartlett, 2011. http://samples.jbpub.com/9780763732745/32745_fmxx_final.pdf. Accessed February 7,

2017.

International Chiropractic Association of California. Management of whiplash associated disorders.

Sacramento CA: International Chiropractors Association of California, 2009.

https://www.californiachiropractic.org/page/whiplash_study.html. Accessed February 7, 2017.

Keith MW, Masear V, Chung K, et al. Diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg.

2009;17(6):389 – 96.

Meekins GD, So Y, Quan D. American Association of Neuromuscular & Electrodiagnostic Medicine

evidenced-based review: use of surface electromyography in the diagnosis and study of neuromuscular

disorders. Muscle Nerve. 2008;38(4):1219 – 24.

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Pullman SL, Goodin DS, Marquinez AI, Tabbal S, Rubin M. Clinical utility of surface EMG: report of the

therapeutics and technology assessment subcommittee of the American Academy of Neurology.

Neurology. 2000;55(2):171 – 77.

Peer-reviewed references:

Bokshen SL, De Passe JM, Eltorai AE, Paxton ES, Green A, Daniels AH. An evidence-based approach to

differentiating the cause of shoulder and cervical spine pain. Am J Med. 2016;129(9):913 – 18.

Dale AM, Agboola F, Yun A, Aeringue A, Al-Lozi MT, Evanoff B. Comparison of automated versus

traditional nerve conduction study methods for median nerve testing in a general worker population.

PM R. 2015;7(3):276 – 82.

de Schepper EI, Overdevest GM, Suri P, et al. Diagnosis of lumbar spinal stenosis: an updated systematic

review of the accuracy of diagnostic tests. Spine (Phila). 2013;38(8):E469 – 81.

Hayes, Inc. Quantitative Sensory Testing for Diagnosis of Lower Extremity Peripheral Neuropathy.

Lansdale PA: Hayes, Inc. November 25, 2013.

Lee CH, Kim HW, Kim HR, Lee CY, Kim JH, Sala F. Can triggered electromyography thresholds assure

accurate pedicle screw placements? A systematic review and meta-analysis of diagnostic test accuracy.

Clin Neurophysiol. 2015;126(10):2019 – 25.

Papanas N, Ziegler D. New diagnostic tests for diabetic distal symmetric polyneuropathy. J Diabetes

Complications. 2011;25(1):44 – 51.

Rubin DI. Technical issues and potential complications of nerve conduction studies and needle

electromyography. Neurol Clin. 2012;30(2):685 – 710.

Schmidt K, Chinea NM, Sorenson EJ, et al. Accuracy of diagnoses delivered by an automated hand-held

nerve conduction device in comparison to standard electrophysiological testing in patients with

unilateral leg symptoms. Muscle Nerve. 2011;43(1):9 – 13.

Strickland JW, Gozani SN. Accuracy of in-office nerve conduction studies for median neuropathy: a meta-

analysis. J Hand Surg Am. 2011;36(1):52 – 60.

CMS National coverage determinations (NCDs):

National Coverage Determination (NCD) for Sensory Nerve Conduction Threshold Tests (sNCTs) (160.23)

Effective April 1, 2004. http://www.cms.gov/medicare-coverage-database/details/ncd-

details.aspx?NCDId=270&ncdver=2&DocID=160.23+&bc=gAAAAAgAAAAAAA%3d%3d&. Accessed

February 7, 2017.

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Local coverage determinations (LCDs):

Local Coverage Determination (LCD): Nerve Conduction Studies and Electromyography (L34594). Revised

10/01/2015, no change to coverage. https://www.cms.gov/medicare-coverage-database/details/lcd-

details.aspx?LCDId=34594&ContrId=143&ver=12&ContrVer=1. Accessed February 7, 2017.

Commonly submitted codes

Below are the most commonly submitted codes for the service(s)/item(s) subject to this policy. This is

not an exhaustive list of codes. Providers are expected to consult the appropriate coding manuals and

bill accordingly.

CPT Code Description Comments

95860 Needle electromyography; 1 extremity with or without related paraspinal areas. And subsequent codes related to electromyography.

95861 Needle electromyography, 2 extremities with or without related paraspinal areas.

95863 Needle electromyography, 3 extremities with or without related paraspinal areas

95864 Needle electromyography, 4 extremities with or without related paraspinal areas

95867 Needle electromyography; cranial nerve supplied muscles, unilateral

95868 Needle electromyography; cranial nerve supplied muscles, bilateral

95870 Needle electromyography, limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral) other than thoracic paraspinal, cranial nerve supplied muscles or sphincters

95872 Needle electromyography using single fiber electrode, with quantitative measurement of jitter, blocking and/or fiber density, any/all sites of each muscle studied

95885 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited

Add-on code

95886

Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels

Add-on code

95887 Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study

Add-on code

95905 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report

Frequently used in “point of care” studies

95907 Nerve conduction studies; 1-2 studies

95908 Nerve conduction studies, 3-4 studies

95909 Nerve conduction studies, 5-6 studies

95910 Nerve conduction studies, 7-8 studies

95911 Nerve conduction studies, 9-10 studies

95912 Nerve conduction studies, 11-12 studies

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CPT Code Description Comments

95913 Nerve conduction studies, 13 or more studies

ICD-10 Code Description Comments

E30.9 Disorder of puberty, unspecified E34.1 Other hypersecretion of intestinal hormones E34.8 Other specified endocrine disorders E34.9 Endocrine disorder, unspecified E35 Disorders of endocrine glands in diseases classified elsewhere G12.21 Amyotrophic lateral sclerosis G50.0 Trigeminal neuralgia G50.1 Atypical facial pain G50.8 Other disorders of trigeminal nerve

G50.9 Disorder of trigeminal nerve, unspecified G51.0 Bell's palsy G51.1 Geniculate ganglionitis G51.2 Melkersson's syndrome G51.3 Clonic hemifacial spasm G51.4 Facial myokymia G51.8 Other disorders of facial nerve G51.9 Disorder of facial nerve, unspecified G52.3 Disorders of hypoglossal nerve G54.0 Brachial plexus disorders G54.1 Lumbosacral plexus disorders

G54.2 Cervical root disorders, not elsewhere classified

G54.3 Thoracic root disorders, not elsewhere classified G54.4 Lumbosacral root disorders, not elsewhere classified G54.5 Neuralgic amyotrophy G54.6 Phantom limb syndrome with pain G54.7 Phantom limb syndrome without pain G54.8 Other nerve root and plexus disorders G54.9 Nerve root and plexus disorder, unspecified G55 Nerve root and plexus compressions in diseases classified elsewhere G56.00 Carpal tunnel syndrome, unspecified upper limb G56.01 Carpal tunnel syndrome, right upper limb G56.02 Carpal tunnel syndrome, left upper limb G56.10 Other lesions of median nerve, unspecified upper limb G56.11 Other lesions of median nerve, right upper limb G56.12 Other lesions of median nerve, left upper limb G56.20 Lesion of ulnar nerve, unspecified upper limb G56.21 Lesion of ulnar nerve, right upper limb G56.22 Lesion of ulnar nerve, left upper limb G56.30 Lesion of radial nerve, unspecified upper limb G56.31 Lesion of radial nerve, right upper limb G56.32 Lesion of radial nerve, left upper limb

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ICD-10 Code Description Comments

G56.40 Causalgia of unspecified upper limb G56.41 Causalgia of right upper limb G56.42 Causalgia of left upper limb G56.80-G56.92 Other specified and unspecified mononeuropathies of upper limb G57.30-G27.62 Lesion of peripheral nerve G57.70 Causalgia of unspecified lower limb G57.71 Causalgia of right lower limb G57.72 Causalgia of left lower limb G57.80-G57.92 Other specified and unspecified mononeuropathies of lower limb G58.7 Mononeuritis multiplex G58.8 Other specified mononeuropathies G58.9 Mononeuropathy, unspecified

G59 Mononeuropathy in diseases classified elsewhere G60.0 Hereditary motor and sensory neuropathy G60.1 Refsum's disease G60.2 Neuropathy in association with hereditary ataxia G60.3 Idiopathic progressive neuropathy G60.8 Other hereditary and idiopathic neuropathies G61.0 Guillain-Barre syndrome G70.00 Myasthenia gravis without (acute) exacerbation G70.01 Myasthenia gravis with (acute) exacerbation G71.11-G73.9 Muscle disorders G83.4 Cauda equina syndrome G93.3 Postviral fatigue syndrome

G95.0 Syringomyelia and syringobulbia M25.511-M25.559

Pain in joint

M33.02 Juvenile dermatopolymyositis with myopathy M33.12 Other dermatopolymyositis with myopathy M33.22 Polymyositis with myopathy M33.92 Dermatopolymyositis, unspecified with myopathy

M34.82 Systemic sclerosis with myopathy M35.03 Sicca syndrome with myopathy M48.04-07 Spinal stenosis M54.2-9 Back and spine pain M62.50-M62.81 Muscle wasting and atrophy M62.9 Disorder of muscle, unspecified M63.80-M63.89 Disorders of muscle in diseases classified elsewhere M79.601-M79.676

Pain in limb

M99.22 Subluxation stenosis of neural canal of thoracic region

M99.23 Subluxation stenosis of neural canal of lumbar region

M99.32 Osseous stenosis of neural canal of thoracic region

M99.33 Osseous stenosis of neural canal of lumbar region

M99.42 Connective tissue stenosis of neural canal of thoracic region

M99.43 Connective tissue stenosis of neural canal of lumbar region

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ICD-10 Code Description Comments

M99.52 Intervertebral disc stenosis of neural canal of thoracic region

M99.53 Intervertebral disc stenosis of neural canal of lumbar region

M99.62 Osseous and subluxation stenosis of intervertebral foramina of thoracic region

M99.63 Osseous and subluxation stenosis of intervertebral foramina of lumbar region

M99.72 Connective tissue and disc stenosis of intervertebral foramina of thoracic region

M99.73 Connective tissue and disc stenosis of intervertebral foramina of lumbar region

R20.0 Anesthesia of skin

R20.1 Hypoesthesia of skin

R20.2 Paresthesia of skin

R20.3 Hyperesthesia

R20.8 Other disturbances of skin sensation

R20.9 Unspecified disturbances of skin sensation

R25.0 Abnormal head movements

R25.1 Tremor, unspecified

R25.2 Cramp and spasm

R25.3 Fasciculation

R25.8 Other abnormal involuntary movements

R25.9 Unspecified abnormal involuntary movements

R29.810 Facial weakness

S04.30XA-S64.8X9A

Injury of nerve

HCPCS Level II Description Comments

G0255 Current perception threshold/sensory nerve conduction test (SNCT), per limb, any nerve [when specified as other portable automated nerve conduction testing]

S3900 Surface electromyography Not covered