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v1.0.0
ICD-10 Guide
ICD-10 CodesG56.1

G56.1

Billable

Other lesions of median nerve

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G56.1 is a billable code used to indicate a diagnosis of other lesions of median nerve.

Key Diagnostic Point:

G56.1 refers to various lesions affecting the median nerve that do not fall under more specific categories such as carpal tunnel syndrome or other well-defined neuropathies. These lesions can arise from a variety of causes, including trauma, compression, or systemic diseases. Clinically, patients may present with symptoms such as pain, numbness, tingling, or weakness in the hand, particularly affecting the thumb, index, and middle fingers. Diagnosis often involves a thorough clinical examination, nerve conduction studies, and imaging techniques to identify the underlying cause of the lesion. Treatment may vary from conservative management, such as splinting and physical therapy, to surgical intervention in cases of significant compression or structural abnormalities. Accurate coding is essential for proper reimbursement and to reflect the complexity of the patient's condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes leading to median nerve lesions.
  • Differentiation from other neuropathies and nerve entrapments.
  • Need for comprehensive documentation of symptoms and diagnostic tests.
  • Potential for overlapping symptoms with other conditions.

Audit Risk Factors

  • Inadequate documentation of symptoms and diagnostic tests.
  • Misclassification of the lesion type.
  • Failure to document the specific location of the lesion.
  • Inconsistent coding practices among different providers.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, results of nerve conduction studies, and imaging reports.

Common Clinical Scenarios

Patients presenting with numbness and tingling in the hand, suspected nerve compression syndromes, or post-traumatic nerve injuries.

Billing Considerations

Ensure that all relevant diagnostic tests are documented to support the diagnosis and treatment plan.

Orthopedics

Documentation Requirements

Surgical notes, pre-operative assessments, and post-operative follow-up documentation.

Common Clinical Scenarios

Patients undergoing surgical intervention for median nerve decompression or repair.

Billing Considerations

Document the specific surgical procedure performed and its relation to the diagnosis.

Coding Guidelines

Inclusion Criteria

Use G56.1 When
  • According to ICD
  • 10 guidelines, G56
  • 1 should be used when the lesion of the median nerve is documented but does not fit into more specific categories
  • Coders should ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use G56.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95903CPT Code

Nerve conduction study, motor and sensory

Clinical Scenario

Used to evaluate the function of the median nerve in patients with suspected lesions.

Documentation Requirements

Results of the nerve conduction study must be documented, including any abnormalities found.

Specialty Considerations

Neurologists and physiatrists often perform these studies.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of median nerve lesions, improving the accuracy of diagnoses and treatment plans. G56.1 provides a distinct code for lesions that do not fit into more defined categories, allowing for better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of median nerve lesions, improving the accuracy of diagnoses and treatment plans. G56.1 provides a distinct code for lesions that do not fit into more defined categories, allowing for better tracking and management of these conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of median nerve lesions, improving the accuracy of diagnoses and treatment plans. G56.1 provides a distinct code for lesions that do not fit into more defined categories, allowing for better tracking and management of these conditions.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of lesions of the median nerve?

Common causes include trauma, repetitive strain injuries, systemic diseases such as diabetes, and compression syndromes.

How do I differentiate between G56.1 and G56.0?

G56.1 is used for other lesions of the median nerve that do not fit the criteria for carpal tunnel syndrome, which is specifically coded as G56.0.