Table 1 Quality Concepts Selected by the ASSH/AAOS Workgroup for Development and Pilot Testing [7]

Measure 1: Discouraging routine use of MRI for diagnosis of CTS

Description: Percent of patients diagnosed with CTS not receiving an MRI in the 90 days before or after the diagnosis.

Type: Process measure using claims data

Denominator: Patients with a diagnosis of CTS (ICD-10-CM: G56.00, G56.01, G56.02, G56.03^a or ICD-9-CM: 354.0)

Numerator: Patients with a diagnosis of CTS who did not receive an ipsilateral wrist MRI to evaluate for carpal tunnel syndrome within 90 days before or after the diagnosis (CPT: 73218, 73219, 73220, 73221, 73222, 73223)

Strength of evidence from CPG: Moderate

Rationale: MRIs are a weak or poor a rule out test for CTS as compared to hand pain diagrams and nerve conduction studies [8].

Measure 2: Discouraging adjunctive surgical procedures during carpal tunnel release (CTR)

Description: Percent of patients diagnosed with CTS who receive CTR who did not receive the following procedures at the same time: Internal neurolysis using operating microscope, radical nine-tendon flexor synovectomy, tenolysis of flexor or extensor tendon, forearm and/or wrist.

Type: Process measure using claims data.

Denominator: Patients with a diagnosis of CTS (ICD-10-CM: G56.00, G56.01, G56.02, G56.03^a or ICD-9-CM: 354.0) who receive CTR (CPT: 64721 or 29848).

Numerator: Patients who did not have any one of the listed procedures completed at the same time (CPT 64727, 25115, 25295).

Strength of evidence from CPG: Moderate

Rationale: Studies have failed to find benefits of adjunctive procedures beyond those for CTR alone [9,10,11,12,13,14,15].

Measure 3. Discouraging routine use of in-clinic occupational and/or physical therapy after CTR

Description: Percent of patients who received CTR and were not prescribed in-clinic postoperative hand, physical, or occupational therapy within 6 weeks after release.

Type: Process measure using claims data.

Denominator: Patients with a diagnosis of CTS (ICD-10-CM: G56.00, G56.01, G56.02, G56.03^a or ICD-9-CM: 354.0) who receive CTR (CPT: 64721 or 29,848)

Numerator: Patients who did not receive in-clinic postoperative hand physical therapy (low, moderate, or high complexity) or occupational therapy (low, moderate, or high complexity) within 6 weeks of CTR (CPT 97161, 97162, 97163, 97165, 97166, 97167)

Strength of evidence from CPG: Moderate

Rationale: Moderate quality studies have failed to find benefits to CTR postoperative rehabilitation of in-clinic OT/PT modalities compared to home programs or placebo [16,17,18,19].