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MP 7.01.23 Tissue Pressure Measurement

Medical Policy
Section
Surgery
Original Policy Date
12/1/95
Last Review Status/Date
Reviewed by consensus/3:2003
Issue
3:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Tissue pressure measurement (TPM) is a procedure for monitoring the pressure of interstitial tissue fluid in a closed fascial or epimyseal space to aid in the evaluation of acute and chronic muscle compartment syndrome. Several techniques can be used to determine this pressure. They include: 1) wick catheter method; 2) slit catheter method; 3) needle manometry method; 4) constant infusion catheter method; 5) solid state transducer intracompartment catheter (STIC) method; and 6) microcapillary infusion (MCI) method.


Policy

Tissue pressure measurement is considered medically necessary under the following conditions:

  • the patient is unconscious;
  • the patient has communication problems; or
  • the clinical signs and symptoms are ambiguous.


Policy Guidelines

No applicable information


Benefit Application

No applicable information


Rationale

A search of literature was completed through the MEDLINE database for the period of January 1993 through January 30, 1995. The search strategy focused on references containing the following Medical Subject Headings:

– Compartment Syndrome/Diagnosis
 
– Tissue

Research was limited to English-language journals on humans.

See also:

TEC Evaluations 1993: Tab 4

 

Codes

Number

Description

CPT 

20950 

Monitoring of interstitial fluid pressure in detection of muscle compartment syndrome 

ICD-9 Procedure 

83.29 

Other diagnostic procedures on muscle, tendon, fascia, and bursa, including that of hand 

ICD-9 Diagnosis 

958.80 

Compartment syndrome; other early complications of trauma 

HCPCS 

No Code 

 

Type of Service 

Diagnostic 

Place of Service 

Inpatient
 
Outpatient
 
Physician’s Office
 


Index

Compartment syndrome
Muscle compartment syndrome
Tissue Pressure Measurement (TPM)
TPM (Tissue Pressure Measurement)


Policy History

Date Action Reason
12/1/95 Add to Surgery section New policy
8/18/00 Replace policy Archived policy
7/12/02 Replace policy Policy reviewed without literature review; new review date only
10/9/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled


 

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