ICD Code M65.4

ICD code M65.4 is used to identify a medical condition known as radial styloid tenosynovitis, commonly referred to as de Quervain's tenosynovitis. This condition involves inflammation of the tendons located on the thumb side of the wrist, specifically affecting the tendons that control thumb movement. It often results in pain and swelling near the base of the thumb, making it difficult to grip or pinch objects. This code is crucial for healthcare providers to accurately document and bill for the diagnosis and treatment of this specific musculoskeletal disorder.

When to use the ICD code for Radial styloid tenosynovitis [de Quervain]:

1. Pain in the wrist or thumb: Patients report localized pain at the base of the thumb or along the radial side of the wrist.

2. Swelling: Noticeable swelling over the radial styloid process or in the area surrounding the thumb.

3. Tenderness: Tenderness upon palpation of the radial styloid area, particularly when pressure is applied.

4. Decreased range of motion: Limited ability to move the thumb or wrist, especially during gripping or pinching activities.

5. Pain with specific movements: Increased pain during activities that involve thumb extension or wrist flexion, such as lifting or gripping objects.

6. Positive Finkelstein test: A clinical test that reproduces pain when the patient makes a fist with the thumb tucked inside the fingers and the wrist is ulnarly deviated.

7. History of repetitive wrist or thumb use: Documentation of activities or occupations that involve repetitive motion of the wrist or thumb, contributing to the condition.

8. Duration of symptoms: Symptoms persisting for a significant period, typically more than a few weeks, indicating a chronic condition rather than an acute injury.

9. Exclusion of other conditions: Ruling out other potential causes of wrist or thumb pain, such as fractures, arthritis, or other tendon injuries.

These criteria should be carefully evaluated to determine the appropriate use of the ICD code.

For the ICD code M65.4, which pertains to radial styloid tenosynovitis [de Quervain], the relevant CPT codes that may be applicable for treatment include:

1. 20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia").

2. 20600 - Arthrocentesis, aspiration and/or injection into a small joint or bursa (e.g., fingers, toes); without ultrasound guidance.

3. 20605 - Arthrocentesis, aspiration and/or injection into an intermediate joint or bursa (e.g., temporomandibular, ankle, wrist, elbow); without ultrasound guidance.

4. 26055 - Tendon sheath incision (e.g., for trigger finger).

5. 26160 - Excision of lesion of tendon sheath or joint capsule (e.g., cyst, mucous cyst, or ganglion), hand or finger.

These CPT codes are commonly used for procedures that may be performed to treat conditions associated with the ICD code M65.4. It is important for healthcare providers to select the appropriate CPT code based on the specific procedure performed and the clinical scenario.

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