Articles
Compliance with electrodiagnostic guidelines for patients undergoing carpal tunnel release

Presented in part to the American Association of Electrodiagnostic Medicine, September 19, 2003, San Francisco, CA.
https://doi.org/10.1016/j.apmr.2004.02.027Get rights and content

Abstract

Storm S, Beaver SK, Giardino N, Kliot M, Franklin GM, Jarvik JG, Chan L. Compliance with electrodiagnostic guidelines for patients undergoing carpal tunnel release.

Objective

To describe how clinical practice in those who underwent carpal tunnel release (CTR) matched the American Association of Electrodiagnostic Medicine (AAEM) 1993 practice parameters for electrodiagnostic evaluation of carpal tunnel syndrome (CTS).

Design

Cohort study using 1998–1999 Medicare billing data.

Setting

Washington State.

Participants

State Medicare beneficiaries who underwent CTR in 1999 (N=1567)

Interventions

Not applicable.

Main outcome measures

Compliance with the AAEM practice parameters.

Results

Of the 324 receiving surgery, 24 (20.7%) did not have any electrodiagnostic testing before surgery. One hundred seventy-one (10.9%) had testing performed that did not lead to the diagnosis of CTS. One thousand seventy-two (68.4%) patients were diagnosed with CTS through electrodiagnostic testing; 155 (9.9%) had less than 2 sensory nerves studied, 114 (7.3%) had less than 2 motor nerves studied, and 65 (4.2%) of the studies met neither the standard (sensory nerve testing) nor guideline (motor nerve testing). In a multivariate analysis, neurologists were more likely than physiatrists not to meet the AAEM standards (adjusted relative risk [adj RR]=1.61; 95% confidence interval [CI], 1.13–2.31) and patients living in rural areas were more likely to have no or inadequate testing (adj RR=1.6; 95% CI, 1.3–1.9).

Conclusions

Over one third of Medicare patients undergoing CTR in Washington State in 1999 may have had an inappropriate electrodiagnostic workup before the surgery. Policymakers should consider mandating an appropriate electrodiagnostic test before approving CTR.

Section snippets

Methods

We performed a retrospective cohort study by using 1998 and 1999 Medicare Part B data. Through the physicians’ Current Procedural Terminology codes, we identified all Washington State Medicare beneficiaries who underwent an open or closed CTR in 1999. We also obtained billing records for all electrodiagnostic studies performed on these patients at least 1 year before their CTR (some patients had up to 2 years of data). The billing records contained the number of motor and sensory nerves tested,

Results

We found billing evidence of 1567 CTRs among Washington State Medicare patients in 1999. Table 2 contains demographics of the study population. Three hundred twenty-four (20.7%) patients did not have any electrodiagnostic testing during the study time frame. Of the remaining 1243 patients (79.3%) who had electrodiagnostic evaluation before surgeries, 1072 (68.4%) were given a diagnosis of CTS by using electrodiagnosis and 171 patients (10.9%) were given other diagnoses (the most frequent of

Discussion

This study shows that more than 20% of the 1567 patients undergoing CTR in Washington State in 1999 did not have an electrodiagnostic examination before surgery. An additional 10.9% had electrodiagnostic testing but were not diagnosed with CTS. Finally, 14.5% of this surgery cohort had electrodiagnostic results leading to a diagnosis of CTS, but the test did not meet AAEM standards. People living in rural areas seem to be particularly at risk for having no or inadequate electrodiagnostic workup

Conclusions

In the Washington State population of Medicare beneficiaries undergoing CTR, 21.4% of patients did not have an electrodiagnostic evaluation before that surgery. An additional 14.4% who received electrodiagnostic testing had evaluations that failed to meet the practice standards as recommended by AAEM. Policymakers should consider altering regulations to ensure that appropriate electrodiagnostic testing is performed before CTR.

Acknowledgments

We thank Lawrence Robinson, MD, Christine Rubadue, ND, and Linda Ruiz, JD, for their assistance with this manuscript.

References (15)

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Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant no. 1 P60 AR48093), the WWAMI Rural Health Research Center, and Centers for Medicare and Medicaid Services (CMS). The views expressed herein are those of the authors and not necessarily of the University of Washington or CMS.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

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