NCS EMG Procedure Desrciption

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Proprietary Information of Blue Cross and Blue Shield of Alabama 1

Name of Policy:

Neuromuscular and Electrodiagnostic Testing (EDX): Nerve

Conduction Studies (NCS) and Electromyography (EMG) Studies

Policy #: 228 Latest Review Date: January 2010

Category: Medicine Policy Grade: A

Background:As a general rule, benefits are payable under Blue Cross and Blue Shield of Alabama health

plans only in cases of medical necessity and only if services or supplies are not investigational,

provided the customer group contracts have such coverage.

The following Association Technology Evaluation Criteria must be met for a service/supply to be

considered for coverage:

1. The technology must have final approval from the appropriate government regulatorybodies;

2. The scientific evidence must permit conclusions concerning the effect of the technology onhealth outcomes;3. The technology must improve the net health outcome;4. The technology must be as beneficial as any established alternatives;5. The improvement must be attainable outside the investigational setting.

Description of Procedure or Service:The electrodiagnostic (EDX) assessment includes two major components: nerve conduction

studies (NCS) and needle electromyography (EMG). NCS are performed to assess the integrity

and diagnose diseases of the peripheral nervous system. These studies specifically measure the

conduction velocity, latency, amplitude, and shape of the neurologic response followingelectrical stimulation of a peripheral nerve through the skin and underlying tissue. The nerve is

stimulated with electrodes placed on the skin in various locations. A mild electrical stimulus is

applied to the nerve, and the response is recorded. Needle electrodes may be used to evaluate anerve that is deep in the tissue, such as the sciatic nerve in the thigh, or the femoral nerve in an

extremely obese individual. Abnormal findings include conduction slowing, conduction block,

no response, and/or low amplitude response. The results of NCS can assess the degree ofdemyelination and axon loss in the segments of the nerve studied. Demyelination results in


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prolongation of conduction time, while axonal loss generally leads to loss of nerve or muscle

potential amplitude.

Nerve conduction studies are routinely performed with needle electromyogram, which enables

the presence and extent of peripheral nerve pathology to be determined. EMG studies measure

the electrical activity of muscles. The EMG results reflect on the integrity of the functioningconnection between a nerve and its innervated muscle. Both tests can help make a clinical

diagnosis of a peripheral nervous system disorder.

Nerve conduction velocity (NCV) measurements are a type of NCS, and are primarily of three

types: motor, sensory, and mixed. Another type of NCS is referred to as late response: F-wave

and H-reflex testing. These are usually performed on nerves more proximal to the spine. Thelate response studies are complementary to NCV studies and are performed during the same

patient evaluation.

The NCS is performed by a physician or by a trained allied health professional under direct

supervision of a physician trained in electrodiagnostic medicine. The American Association ofNeuromuscular and Electrodiagnostic Medicine (AANEM) states, NCSs should be either (a)

performed directly by physician or (b) performed by a trained individual under the directsupervision of a physician. Direct supervision means that the physician is in close physical

proximity to the EDX laboratory while testing is underway, is immediately available to provide

the trained individual with assistance and direction, and is responsible for selecting theappropriate NCSs to be performed. The EMG is always performed by a physician.

Nerve Conduction Studies:

NCS (CPT 95900-95904) specifically assess the speed (conduction velocity, and/or latency), size

(amplitude), and shape of the response. Pathological findings include conduction slowing,conduction block, no response, and/or low amplitude response.

A typical NCS examination should include the following:

Development of a differential diagnosis by the EDX consultant, based upon appropriatehistory and physical examination.

NCS of a number of nerves by recording and studying the electrical responses fromperipheral nerves or the muscles they innervate, following electrical stimulation of thenerve. Usually surface electrodes are used for both stimulation and recording, though

needle electrodes may be required in special cases.

Completion of indicated EMG studies to evaluate the differential diagnosis and tocomplement the NCSs.

Motor NCSs (CPT codes 95900 and 95903) are performed by applying electrical stimulation atvarious points along the course of a motor nerve while recording the electrical response from an

appropriate muscle. Response parameters include amplitude, latency, configuration, and motorconduction velocity.

Sensory NCSs (CPT code 95904) are performed by applying electrical stimulation near a nerveand recording the response from a distant site along the nerve. Response parameters include

amplitude, latency, configuration, and sensory conduction velocity.


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Mixed NCSs (CPT code 95904) are performed by applying electrical stimulation near a nerve

containing both motor and sensory fibers (a mixed nerve) and recording from a different locationalong that nerve that also contains both motor and sensory nerve fibers. Response parameters

include amplitude, latency, configuration, and both sensory and motor conduction velocity.

Needle Electromyography:

A typical EMG examination includes the following:

Development of a differential diagnosis by the EDX consultant, based upon appropriatehistory and physical examination.

Completion of indicated NCSs to evaluate the differential diagnosis and to complementthe needle EMG studies.

Needle EMG testing of selected muscles. This is accomplished by inserting a needleelectrode into appropriate muscles, one at a time. The needle electrode allows the

muscles electrical characteristics at rest and during activity to be interpreted by the EDXconsultant. This interpretation includes analysis of oscilloscope tracings and the

characteristic sounds produced by electrical potentials. The final interpretation of the

study is a synthesis by the EDX consultant of the patients history, physical examination,

and the preceding and following portions of the study.

Needle EMG studies are interpreted in real time, as they are being performed. Normal

findings and abnormalities uncovered during the study are documented and interpreted.Needle EMG reports should document the muscles tested, and report the presence and type

of spontaneous activity; as well as the characteristics of the voluntary unit potentials.

Late Responses: H-Reflex and F-Wave Studies:

Motor and sensory NCS and late responses (F-wave and H-reflex studies) are often

complementary and performed during the same patient evaluation.

The F-wave and H-reflex studies are performed to evaluate nerve conduction in portions of the

nerve more proximal (near the spine) and, therefore, inaccessible to direct assessment using

conventional techniques. Electrical stimulation is applied on the skin surface near a nerve site ina manner that sends impulses both proximally and distally. Characteristics of the response are

assessed, including latency.

The F-wave and H-reflex studies provide information in the evaluation of radiculopathies,

plexopathies, polyneuropathies (especially with multifocal conduction block or in suspected

Guillain-Barr syndrome or chronic inflammatory demyelinating polyneuropathy), and proximalneuropathies. In some cases, they may be the only abnormal study.

H-Reflex Studies:

Typically, only 2 H-reflex studies are performed in a given examination.

H-reflex studies usually must be performed bilaterally because symmetry of responses is an

important criterion for abnormality. When a bilateral H-reflex study is performed, the entireprocedure must be repeated, increasing examiner time and effort; there are no economies of scale

in multiple H-reflex testing.


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H-reflex studies usually involve assessment of gastrocnemius/soleus muscle complex in the calf.Bilateral gastrocnemius/soleus H-reflex abnormalities are often early indications of spinal

stenosis or bilateral S1 radiculopathies.

In rare instances, H-reflexes need to be tested in muscles other than the gastrocnemius/soleusmuscle, e.g., in the upper limbs. In conditions such as cervical radiculopathies or brachial

plexopathies, an H-reflex study can be performed in the arm (flexor carpi radialis muscle). Other

muscles that may be tested, although rarely, are the intrinsic small muscles of the hand and foot.

F-Wave Study:

The set-up for an F-wave study is similar to the set-up for a motor NCS. However, the testing isperformed separately from motor NCS, and utilizes different machine settings and separate

stimulation to obtain a larger number of responses (at least 10).

The number of F-wave studies that need to be performed on a given patient depends on the

working diagnosis and the electrodiagnostic findings already in evidence. It may be appropriatein the same patient to perform some motor NCS with an F-wave and others without an F-wave.

Blink Reflexes:

The blink reflex is an electrophysiologic analog of the corneal reflex. It is used to evaluate

disease involving the 5th

or 7th

cranial nerves or in the brainstem. The latency of responses,including side-to-side differences, can help localize pathology in the region of the 5

thor 7

th

cranial nerve, or in the brainstem. The latencies and amplitudes of directly elicited facial motor

responses should be determined to exclude a peripheral abnormality if the blink reflexes areabnormal.

Recordings should be made bilaterally with both ipsilateral and contralateral stimulation.

Single Fiber Electromyography:

In single-fiber electromyography (SFEMG) (CPT code 95872), a specially designed needleelectrode is used to record and identify action potentials (APs) from individual muscle fibers.

These recordings are used to calculate the neuromuscular jitter and the muscle fiber density

(FD). Jitter is the variability in time between activation of the motor nerve and generation of themuscle fiber AP, and reflects the normality of nerve-muscle transmission. Jitter may be assessed

by measuring the time variability between Aps from two muscle fibers in the same voluntarily

activated motor unit, or by stimulating the motor axon and measuring the variability betweenstimulus and Aps in the responding muscle fibers.

Normal jitter varies among muscles and among muscle fibers within individual muscles, but isgenerally in the range of 10 to 50 s. To determine if jitter is abnormally increased, statistical

analysis is performed on the results from recordings from a population of muscle fibers within

each tested muscle. When neuromuscular transmission is sufficiently abnormal that nerve

activation produces no muscle AP, blocking is seen. Increased jitter, blocking or both, mayoccur in a variety of conditions, including primary disorders of neuromuscular transmission.


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FD is a measurement of the mean number of muscle fibers belonging to the same motor unit

detected by the SFEMG electrode at a number of different insertions sties during voluntaryactivation of the motor unit.

Needle EMG should be performed in as least one clinically involved muscle before attributing

pathologic jitter or blocking to a neuromuscular transmission disorder.

The results of jitter testing in each muscle are reported as the mean jitter among all pairs of APs

recorded during voluntary activation (or the mean jitter of all APs recorded during axonalstimulation), the percentage of pairs (or APs) in which blocking was seen, and the percentage of

pairs (or APs) in which jitter was normal. FD is reported as the mean number of muscle fibers

per motor unit at 20 recording sites for each muscle tested.

Jitter and FD may be measured in one or more muscles depending on the condition being

evaluated and the results of testing.

The physicians report should identify the muscles tested. Characteristics of the examinationshould be noted as described in the overview of needle EMG above, as well as specific

discussion about the presence or absence of jitter and other abnormalities in the muscles tested.

Needle Electromyography of Anal or Urethral Sphincter:

Under specific circumstances in which there is suspicion of injury to the sacral roots of the spinalcord, separate study of the anal sphincter is required since this is the only muscle accessible to

needle EMG examination that receives its innervation through these roots. This test may also be

performed to assess the innervation and anatomic integrity of the sphincters.

Policy:

Electrodiagnostic studies (NCS and EMG) meet Blue Cross and Blue Shield of Alabamasmedical criteria for coverage in any of the following conditions:

1. Localization of focal neuropathies or compressive lesions;2. Diagnosis and prognosis of traumatic nerve lesions or other nerve trauma;3. Diagnosis or confirmation of suspected generalized neuropathies (e.g., diabetic,

uremic, metabolic or immune);

4. Motor neuronopathy conditions (e.g., amyotrophic lateral sclerosis [ALS or LouGehrigs disease]):

a. Up to 4 motor nerves and 2 sensory nerves may be studiedb. Needle EMG of up to 4 extremities (or limbs and facial or tongue muscles) is

often necessary to document widespread denervation and to exclude a myopathy.c. One repetitive motor nerve stimulation study may be indicated to exclude adisorder affecting neuromuscular transmission;

5. Diagnosis of neuromuscular junction disorders (e.g., myasthenia gravis/myasthenicsyndrome) or other neuromuscular conditions (e.g., fasciculation [muscle twitching])using repetitive nerve stimulation:

a. Repetitive NCSs should be performed in up to 2 nerves and SFEMG in up to 2muscles,


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b. If any of the above tests are abnormal, up to 2 motor and 2 sensory NCSs may beperformed to exclude neuropathies that can be associated with abnormalneuromuscular transmission;

c. At least 1 motor and 1 sensory NCS should be performed in a clinically involvedlimb, preferable in the distribution of a nerve studied with repetitive stimulation

or SFEMG;d. At least 1 distal and 1 proximal muscle should be studied by a needle EMGexamination;

i. At least 1 of the muscles should be clinically involved and both musclesshould be in clinically involved limbs;

6. Differential diagnosis of symptom-based complaints (e.g., pain in limb or joint,weakness, disturbance in skin sensation or paresthesia, swelling and/or cramping injoints and/or limbs) provided the clinical assessment supports the need for a study;

7. Follow-up treatment of diabetic peripheral neuropathy, tested once every 24 months;8. Carpal tunnel syndrome (unilateral, bilateral) :

a. For patients with suspected carpal tunnel syndrome (CTS), the followingrecommendations were made and endorsed by the American Academy ofNeurology (AAN), the American Academy of Physical Medicine and

Rehabilitation, and the American Association of Electrodiagnostic Medicine(AAEM):

i. Perform a median sensory NCS across the wrist with a conductiondistance of 13 to 14 cm. If the result is abnormal, do a comparison of theresult of the median sensory NCS to the result of a sensory NCS of one

other adjacent sensory nerve in the symptomatic limb.

1. If the initial median sensory NCS across the wrist has a conductiondistance > 8 cm and the result is normal, do one of the following

additional studies:2. Comparison of median sensory or mixed nerve conduction across

the wrist over a short (7-8 cm) conduction distance with ulnar

sensory nerve conduction across the wrist over the same short (7-8

cm) conduction distance; OR3. Comparison of median sensory conduction across the wrist with

radial or ulnar sensory conduction across the wrist in the same

limb; ORii. Comparison of median sensory or mixed nerve conduction through the

carpal tunnel to sensory or mixed NCS of proximal (forearm) or distal

(digit) segments of the median nerve in the same limb.iii. Motor conduction studies of the median nerve recording from the muscle

and of one other nerve in the symptomatic limb to include measurement of

distal latency.iv. NCS may be done pre-op a maximum number of times as listed in the

chart below. NSC may be indicated one time post op, to provide

reassessment concerning possible failure of surgery

b. Post-surgical repair of CTS, to assess possible failure of treatment, tested onetime.

9. Disorders of peripheral nervous system;


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10. Radiculopathy:a. Radiculopathies cannot be diagnosed by NCS alone. Needle EMG must be

performed to confirm a radiculopathy.

b. These studies should be performed together by 1 physician supervision and/orperforming all aspects of the study.

c.

H reflexes and F waves may be necessary to support a diagnosis of rootdysfunction.

d. Minimal evaluation includes 1 motor and 1 sensor NCS and a needle EMGexamination of the involved limb

i. Testing can include up to 3 motor NCSs (in cases of an abnormal motorNCS, the same nerve n the contralateral limb and another motor nerve in

the ipsilateral limb can be studied) and 2 sensory NCSsii. Bilateral studies are often necessary to exclude a central disc herniation

with bilateral radiculopathies or spinal stenosis or to differentiate between

radiculopathy and plexopathy, polyneuropathy, or mononeuropathy.

e. To differentiate brachial plexopathy form cervical radiculopathy, all majorsensory and motor nerves (radial, median, ulnar, and medial and lateralantebrachial cutaneous sensory; radial, median ulnar and possibly axillary and

musculocutaneous motor) and a needle EMG examination in both upperextremities may need to be studied

f. To differentiate lumbosacral radiculopathy from lumbar plexopathy, it may benecessary to study all major sensory and motor nerves (superficial peroneal andsural sensory; peroneal and posterior tibial motor) and perform a needle EMG

examination in both lower extremities;

11. Myopathy:a. A needle EMG examination of 2 limbs is indicated.b. To exclude polyneuropathy or neuronopathy, 2 motor and 2 sensory NCSs are

indicated.

c. To exclude a disorder of neuromuscular transmission, 2 repetitive motor nervestimulation studies may be needed;

12. Myositis;13. Nerve root compression;14. Neuritis;15. Plexopathy;16. Spinal cord injury;17. Polyneuropathy/mononeuropathy multiplex:

a. To distinguish the nature of the polyneuropathy (axonal or demyelinating, diffuseor multifocal) it may be necessary to study 4 motor and 4 sensory nerves,

consisting of 2 motor and 2 sensory NCS in 1 leg, 1 motor and 1 sensory NCS in

the opposite leg and 1 motor and 1 NCS in 1 arm.b. At least 2 limbs should be studied by a needle EMG.

Frequency of Testing

Services performed for excessive frequency do not meet Blue Cross and Blue of Alabamasmedical criteria for coverage. Frequency is considered excessive when services are performed

more frequently than generally accepted by AANEM.


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The AANEM lists these recommendations concerning a reasonable maximum number of NCVstudies per diagnostic category needed for a physician to render a diagnosis:

Maximum Number of Studies

NeedleElectromyography,

CPT 95860-95864

and 95867-95870

Nerve ConductionStudies

CPT 95900,

95903, 95904

OtherElectromyographic

Studies

CPT 95934,95936, 95937

Indication

Number of Services

(Tests)

MotorNCS

with

and/orwithout F

wave

Sensory

NCS H-

Reflex

NeuromuscularJunction Testing

(Repetitive

Stimulation)

Carpal Tunnel (unilateral) 1 3 4

Carpal Tunnel (bilateral) 2 4 6Radiculopathy 2 3 2 2

Mononeuropathy 1 3 3 2

Polyneuropathy/Mononeuropathy

Multiplex

3 4 4 2

Myopathy 2 2 2 2

Motor Neuronopathy (e.g.,ALS)

4 4 2 2

Plexopathy 2 4 6 2

Neuromuscular Junction 2 2 2 3Tarsal 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, orTingling (unilateral)

1 3 4 2

Pain, Numbness, orTingling (bilateral)

2 4 6 2


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These limits will not apply if the patient requires evaluation by more than one EDX consultant

(i.e., a second opinion or an expert opinion at a tertiary care center) in a given year or if thepatient requires evaluation for a second diagnosis in a given year.

Nerve conduction studies (NCS) do not meet Blue Cross and Blue Shield of Alabamas

medical criteria for the following indications:

1. The F-wave study for carpal tunnel syndrome.2. NCS as screening tests for polyneuropathy of diabetes or end-stage renal disease.3. NCS for the sole purpose of monitoring disease intensity or treatment effectiveness

for polyneuropathy of diabetes or end-stage renal disease.

4. NCS using portable automated point-of-care hand-held devices. Examples of thesenerve conduction testing devices include, but are not limited to, NC-Stat by

NeuroMetrix, Neurometer and Brevio NCS-Monitor. See Policy #304 for

additional information regarding Automated Point-of-Care Nerve Conduction Tests.

5. NCS done by mobile neurodiagnostic labs.6.

NCS done by technicians alone, not under direct supervision of a trained physician.a. Direct supervision in the office setting means the physician must be present in the

office suite and immediately available and able to provide assistance anddirection throughout the time the service is performed. Direct supervision does

not mean that the physician must be present in the same room with his or her aide

Surface EMG testing does not meet Blue Cross and Blue Shield of Alabamas medical criteriafor coverage. See Policy #362 ParaspinalSurface Electromyography (SEMG) to Evaluate

and Monitor Back Pain.

Blue Cross and Blue Shield of Alabama does not approve or deny procedures, services, testing,

or equipment for our members. Our decisions concern coverage only. The decision of whether

or not to have a certain test, treatment or procedure is one made between the physician and

his/her patient. Blue Cross and Blue Shield of Alabama administers benefits based on the

members' contract and corporate medical policies. Physicians should always exercise their best

medical judgment in providing the care they feel is most appropriate for their patients. Needed

care should not be delayed or refused because of a coverage determination.

Key Points:The American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM,

formerly AAEM) has publishedThe Electrodiagnostic Medicine Consultation which was

originally put together in 1994 at a conference of 43 experts in the field. It has been revised andmost recently updated in 2004. The document provides overviews and recommendations

concerning the field of electrodiagnostic medicine.

The American Board of Electrodiagnostic Medicine is an independent credentialing body in

electrodiagnostic medicine. Its goal is to enhance the quality of patient care through a voluntary

certification process.


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The AANEM has issued a policy statement with these minimum standards:

1. The tests should be medically indicated.2. The tests should be performed using equipment that provides assessment of all

parameters of the recorded signals. Equipment designed for screening

purposes is not acceptable.

3.

The NCS should be performed by a physician or by a trained technician underthe direct supervision of a physician.

a. Blue Cross and Blue Shield of Alabama defines direct supervision as: Directsupervision in the office setting means the physician must be present in the office

suite and immediately available and able to provide assistance and direction

throughout the time the service is performed. Direct supervisiondoes not meanthat the physician must be present in the same room with his or her aide

4. A trained physician must perform the needle EMG exam.5. One physician should perform and supervise all components of the

electrodiagnostic testing.

The AANEM also issued a position statement on who is qualified to practice electrodiagnostic

medicine. In summary, the following recommendations are made:

1. EDX consultations must be performed by physicians who have comprehensiveknowledge of neurological and musculoskeletal disorders (usually a neurologist

or physiatrist).

2. The NCS should be performed under the direct supervision of an EDXconsultant.

3. The needle EMG exam must be performed by the physician.Key Words:Electrodiagnostic medicine, nerve conduction studies (NCS), nerve conduction velocity studies,

motor nerve conduction studies, sensory nerve conduction studies, mixed nerve conductionstudies, needle electromyography (EMG), late responses, H-reflex studies, F-wave studies

single-fiber electromyography (SFEMG), NC-stat System, NC-Stat by NeuroMetrix,

Neurometer and Brevio NCS-Monitor.

Approved by Governing Bodies:Not applicable

Benefit Application:Coverage is subject to members specific benefits. Group specific policy will supersede this

policy when applicable.ITS: Home Policy provisions apply

BellSouth/AT&T contracts: No special considerationFEP contracts: No special consideration

Wal-Mart: Special benefit consideration may apply. Refer to members benefit plan.Pre-certification requirements: Not applicable

Pre-determination requirements: Not applicable

Coding:


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CPT codes: 95860 Needle electromyography; one extremity, with or without related

paraspinal areas95861 Needle electromyography; two extremities, with or without related

paraspinal areas

95863 Needle electromyography; three extremities, with or without related

paraspinal areas95864 Needle electromyography; four extremities, with or without related

paraspinal areas

95867 Needle electromyography; cranial nerve supplied muscle(s), unilateral95868 Needle electromyography; cranial nerve supplied muscles; bilateral

95869 Needle electromyography; thoracic paraspinal muscles (excluding T1

95870 Needle electromyography; limited study of muscles in one extremityor non-limb (axial) muscles (unilateral or bilateral), other than

thoracic paraspinal, cranial nerve supplied muscles, or sphincters

95872 Needle electromyography using single fiber electrode, with

quantitative measurement of jitter, blocking and/or fiber density,

any/all sites of each muscle studied95900 Nerve conduction, amplitude and latency/velocity study, each nerve;

motor, without F-wave study95903 Nerve conduction, amplitude and latency/velocity study, each nerve;

motor, with F-wave study

95904 Nerve conduction, amplitude and latency/velocity study, each nerve;sensory

95934 H-reflex, amplitude and latency study; record gastrocnemius/soleus

muscle95936 H-reflex, amplitude and latency study; record muscle other than

gastrocnemius/soleus muscle51785 Needle electromyography (EMG) studies of anal or urethral

sphincter, any technique

Effective for dates of service on or after January 1, 2006:

95865 Needle electromyography; larynx

95866 Needle electromyography; hemidiaphragm

HCPCS code: S3900 Surface electromyography (EMG)

References:1. American Association of Neuromuscular and Electrodiagnostic Medicine, American

Academy of Neurology, American Academy of Physical Medicine and Rehabilitation,Recommended policy for electrodiagnostic medicine, AANEM 1995-2005,http://www.aanem.org/practical issues/recpolicy/recommended_policy_1.cfm.

2. Aramideh M and Ongerboer B. Brainstem reflexes: Electrodiagnostic techniques,physiology, normative data, and clinical applications, Muscle and Nerve, July 2002; 26: 14-30.

3. Barboi A and Barkhaus P. Electrodiagnostic testing in neuromuscular disorders,Neurologic Clinics 2004; 22: 619-641.
http://www.aanem.org/practical%20issues/recpolicy/recommended_policy_1.cfmhttp://www.aanem.org/practical%20issues/recpolicy/recommended_policy_1.cfmhttp://www.aanem.org/practical%20issues/recpolicy/recommended_policy_1.cfm


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4. Braune HJ. Testing of the refractory period in sensory nerve fibers is the most sensitivemethod to assess beginning polyneuropathy in diabetes, Electromyography and ClinicalNeurophysiology, September 1999; 39(6): 355-359.

5. Chang MH, et al. Comparison of motor conduction techniques in the diagnosis of carpaltunnel syndrome, Neurology, June 2002, Vol. 58, No. 11.

6.

Concannon MJ, et al. The predictive value of electrodiagnostic studies in carpal tunnelsyndrome, Plastic and Reconstructive Surgery, November 1997; 100(6): 1452-1458.

7. FDA 510(k) Summary Brevio. www.fda.gov/cdrh/pdf6/K061828.pdf Accessed April2008.

8. Goetz: Textbook of Clinical Neurology, 2ndedition. Electromyography, 2003.9. Goetz: Textbook of Clinical Neurology, 2ndedition. Nerve conduction studies, 2003.10. Hilburn JV. General principles and use of electrodiagnostic studies in carpal and cubital

tunnel syndromes with special attention to pitfalls and interpretation, Hand Clinics, May1996; 12(2): 205-221.

11. http://www.viasyshealthcare.com/prod_serv/downloads/202_TECA_Synergy_Brochure.pdfAccessed April 2008.

12.

Iyer VG. Understanding nerve conduction and electromyographic studies, Hand Clinics,May 1993; 9(2): 273-287.13. Jablecki CK, et al. Practice parameters: Electrodiagnostic studies in carpal tunnel

syndrome, Neurology, June 2002, Vol. 58, No. 11.

14. Kaufman MA. Differential diagnosis and pitfalls in electrodiagnostic studies and specialtests for diagnosing compressive neuropathies, Orthopedic Clinics of North America, April

1996; 27(2): 245-252.15. Levin KH. Common focal mononeuropathies and their electrodiagnosis, Journal of

Clinical Neurophysiology, April 1993; 10(2): 181-189.

16. Murthy JM. Carpal tunnel syndrome-electrodiagnostic aspects of fifty-seven symptomatichands, Neurology India 1999; 47(4): 272-275.

17. Vinik AI, et al. Diabetic neuropathies, Medical Clinics of North America 2004; 88 : 947-999.

18. Wilbourn AJ, et al. AAEM Minimonograph 32: The electrodiagnostic examination inpatients with radiculopathies, Muscle and Nerve, December 1998, Vol. 21, pp. 1612-1631.

19. Wilbourn AJ. Nerve conduction studies. Types, components, abnormalities, and value inlocalization, Neurologic Clinics of North America 2002, Vol. 20, pp. 305-338.

Policy History:Medical Policy Group, June 2005 (2)Medical Policy Group, November 2005 (2)

Medical Policy Administration Committee, November 2005

Available for comment December 1, 2005-January 14, 2006Medical Policy Group, April 2007 (2)

Medical Policy Administration Committee, April 2007

Medical Policy Group, April 2008 (2)Medical Policy Administration Committee, April 2008

Available for comment April 4-May 18, 2008

Medical Policy Group, April 2008 (2)

Medical Policy Administration Committee May 2008
http://www.fda.gov/cdrh/pdf6/K061828.pdfhttp://www.fda.gov/cdrh/pdf6/K061828.pdfhttp://www.viasyshealthcare.com/prod_serv/downloads/202_TECA_Synergy_Brochure.pdfhttp://www.viasyshealthcare.com/prod_serv/downloads/202_TECA_Synergy_Brochure.pdfhttp://www.fda.gov/cdrh/pdf6/K061828.pdf


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Available for comment May 3-June 16, 2008

Medical Policy Group, June 2008 (2)Medical Policy Administration Committee, July 2008

Available for comment June 17-July 31, 2008

Medical Policy Group, June 2009 (2)

Medical Policy Group, July 2009 (2)Medical Policy Group, August 2009 (2)

Medical Policy Administration Committee, August 2009

Available for comment August 10-September 23, 2009Medical Policy Group, January 2010 (2)

Medical Policy Administration Committee, January 2010

Available for comment January 26-March 11, 2010

This medical policy is not an authorization, certification, explanation of benefits, or a contract. Eligibility and benefits are determined on a case-

by-case basis according to the terms of the members plan in effect as of the date services are rendered. All medical policies are based on (i)

research of current medical literature and (ii) review of common medical practices in the treatment and diagnosis of disease as of the date

hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and

levels of care and treatment.

This policy is intended to be used for adjudication of claims (including pre-admission certification, pre-determinations, and pre-procedure

review)in Blue Cross and Blue Shields administration of plans contracts.

NCS EMG Procedure Desrciption

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