Notification



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Policy Attachment


Attachment to Policy # 07.03.18o


Attachment:A

Policy #:07.03.18o

Description:Recommended Guidelines for Electrodiagnostic Studies

Title:Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies


Recommended Guidelines for Electrodiagnostic Studies

The table below lists the recommended guidelines for electrodiagnostic (EDX) studies according to the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Table 1 lists the reasonable maximum number of studies per diagnostic category that is necessary to arrive at a diagnosis in 90 percent of individuals. Each number in the table represents one study or unit. This table is a tool to detect outliers and to prevent abuse and overutilization of these studies.

Although these numbers apply to a variety of practice styles and types, the appropriate number of studies to be performed for each individual depends primarily upon the judgment of the performing provider. For simple, straightforward cases, fewer tests may be necessary; however, for complex cases, when results of critical tests may be normal or borderline, the maximum number in the table may be insufficient to make a complete diagnosis. In some individuals, multiple diagnoses are established by EDX testing; therefore, the recommendations listed in the table for a single diagnostic category do not apply.

In circumstances where testing in excess of the maximum number is required, supplementary documentation in the medical record is required to justify additional testing. Such documentation should explain the other differential diagnoses that need to be ruled out.

In some situations, an asymptomatic contralateral limb should be studied to establish normative values. Because results obtained via contralateral symptomatic limb testing in the individual are likely to be more sensitive for diagnosis than the normative values based on the general population, restrictions on this type of testing are not recommended.


Table 1: Maximum Number of Studies
Needle Electro-
myography
Nerve Conduction Studies
Other Electromyographic Studies


Indication
Number of Services
(Tests)
Motor NCS with and/or without F-wave Studies
Sensory NCS
H-reflex Studies
Neuromuscular Junction Testing (Repetitive Stimulation)
Carpal Tunnel (unilateral)
1
3
4
Carpal Tunnel (bilateral)
2
4
6
Radiculopathy
2
3
2
2
Mononeuropathy
1
3
3
2
Polyneuropathy/
Mononeuropathy Multiplex
3
4
4
2
Myopathy
2
2
2
2
Motor Neuronopathy (eg, ALS)
4
4
2
2
Plexopathy
2
4
6
2
Neuromuscular Junction
2
2
2
3
Tarsal Tunnel Syndrome (unilateral)
1
4
4
Tarsal Tunnel Syndrome (bilateral)
2
5
6
Weakness, Fatigue, Cramps, or Twitching (focal)
2
3
4
2
Weakness, Fatigue, Cramps, or Twitching (general)
4
4
4
2
Pain, Numbness, or Tingling (unilateral)
1
3
4
2
Pain, Numbness, or Tingling (bilateral)
2
4
6
2


EXAMPLES OF CLINICAL SITUATIONS WHERE ADDITIONAL TESTING IS MEDICALLY NECESSARY
  • Second diagnosis
    When a single diagnosis is made on the first visit, but the individual subsequently develops a new set of symptoms, further evaluation is required for a second diagnosis in order for treatment to begin.
  • Inconclusive diagnosis
    When a serious diagnosis (eg, ALS) is suspected, but the results of needle EMG examination are inconclusive, follow-up studies are needed to establish or exclude a diagnosis.
  • Rapidly evolving disease
    In some diseases, initial needle EMG/NCS testing may not show any abnormality in the first one to two weeks (eg, Guillain-Barré syndrome). An early diagnosis, confirmed by repeat testing, must be made quickly so that treatment can begin. Follow-up testing can be extremely useful in establishing prognosis and monitoring patient status.
  • Course of the disease
    Certain diseases, such as polymyositis and myasthenia gravis, follow a fluctuating course with variable response to treatment. The professional provider needs to monitor disease progression and therapeutic response. The results of follow-up evaluations may be necessary to guide treatment decisions.
  • Unexpected course or change in course of the disease
    In certain situations, management of a diagnosed condition may not yield expected results, or new, questionably related problems may occur (eg, failure to improve following surgery for radiculopathy). In these instances, re-examination is appropriate.
  • Recovery from injury
    Repeat evaluations may be needed to monitor recovery, to help establish prognosis, and/or to determine the need for and the timing of a surgical intervention (eg, traumatic nerve injury).


Version Effective Date: 10/01/2019
Version Issued Date: 10/02/2019
Version Reissued Date: 11/20/2019

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