Current RMA Instruments
| Reasonable Hypothesis SOP | 72 of 2023 |
| Balance of Probabilities SOP | 73 of 2023 |
Changes from previous Instruments
ICD Coding
ICD-10-AM Codes: G58.7, G62, G63, G90
Brief description
The term peripheral neuropathy can be used to describe any disorder of the peripheral nervous system, i.e. those nerves outside the brain and spinal cord. This can include polyneuropathy (a process affecting many peripheral nerves), radiculopathy (a damaged nerve root in the spinal canal causing problems along the course of the nerve) and mononeuropathy (focal involvement of a single nerve). Peripheral neuropathy can involve sensory, motor or autonomic nervous functioning. The SOP covers non-traumatic polyneuropathies and some other specific conditions, but not isolated mononeuropathies.
Confirming the diagnosis
This SOP covers some but not all of the disorders of the peripheral nerves. Before applying the SOP, check that the claimed condition is not one of the many neuropathies excluded from this SOP (see list, below). Generally for the SOP to apply, the disorder will involve multiple peripheral nerves. Consistent symptoms need to be present. Signs of peripheral neuropathy and/or positive electromyography (nerve conduction) test results are also required to apply this SOP.
The appropriate medical specialist is a neurologist.
Additional diagnoses covered by SOP
- Peripheral autonomic neuropathy
- Mononeuritis multiplex
- Polyneuropathy
Additional diagnoses that may be covered by SOP
- Plexopathy (excluding thoracic outlet syndrome or other nerve compression or trauma-related disorders)
- Radiculopathy that is non-traumatic:
- entrapment or compression of nerve roots by spondylosis, intervertebral disc prolapse, spinal stenosisis or other pathologies involving trauma to the nerve roots is excluded
- immune polyradiculopathy is excluded
Conditions not covered by SOP
- Amyotrophic lateral sclerosis* - motor neuron disease SOP
- Autoimmune nodopathy#
- Bell’s palsy#
- Carpal tunnel syndrome*
- Cerebrovascular accident*
- Cerebral tumors *
- Charcot-Marie-Tooth disease*
- Chronic immune polyradiculopathy (sensory and/or motor)#
- Chronic inflammatory demyelimating polyneuropathy#
- Complex regional pain syndrome*
- Congenital/hereditary neuropathies#
- Cranial nerve disorders/neuropathies
- Cubital tunnel synmdrome#
- Guillian-Barré syndrome*
- Intercostal neuropathies#
- Meralgia paraesthetica#
- Mononeuropathies - may be covered by separate SOPs e.g. carpal tunnel syndrome
- Morton metatarsalgia/neuralgia/neuroma*
- Motor neuron disease*
- Multifocal motor neuropathy#
- Multiple sclerosis*
- Muscle disorders#
- Myasthenia gravis*
- Myelitis#
- Myelopathy#
- Myopathies#
- Neuralgic amyotrophy#
- Neurogenic thoracic outlet syndrome* - thoracic outlet syndrome SOP
- Neuromuscular disorders#
- Neuropathies due to trauma (burn, electrical injury, traumatic brain injuries)
- Periodic limb movement disorder*
- Restless legs syndrome*
- Sciatica - may be covered by thoracolumbar spondylosis or intervertebral disc prolapse SOPs
- Tarsal tunnel syndrome#
- Trigeminal neuralgia*
- Trigeminal neuropathy*
- Ulnar neuropathy at the elbow*
* another SOP applies
# non-SOP condition
Clinical onset
The nature of the clinical onset depends on the type or neuropathy and the cause of the condition. Onset may be sudden or gradual. A common presentation is a distal, symmetric sensory loss, burning, or weakness in the lower limbs.
Clinical worsening
Appropriate clinical management varies but may involve treatment of any underlying disease, cessation of exposure to any triggering substance and alleviation of symptoms. Consideration of whether there has been worsening beyond the normal course of the condition will generally require specialist medical opinion.