Rob Rubenstein MD Neurologist - The Doctors Clinic Topic – EMG/NCV Testing.
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Transcript of Rob Rubenstein MD Neurologist - The Doctors Clinic Topic – EMG/NCV Testing.
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Rob Rubenstein MDNeurologist - The Doctors Clinic
Topic – EMG/NCV Testing
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Follow up on Botox for Migraine
• Old code: 64612 and 64613 (modified)• New code: 64615
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EMG/NCV Testing
-What it means-Why we do it
-How we code it
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It’s not torture!
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NCV = Nerve Conduction Velocity
• It simply determines how fast a nerve transmits it’s electrical signal
• It assesses the peripheral nerves only – “motor” & “sensory”
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What it doesn’t do
• Doesn’t detect central nervous system problems like stroke, Multiple Sclerosis, brain tumors, etc…
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Common nerve problems evaluated by nerve conduction testing
• Carpal tunnel syndrome• Ulnar, peroneal neuropathy• Peripheral neuropathy – e.g. diabetes, alcohol,
chemotherapy
And some less common disorders – Guillain Barre syndrome, CIDP, ALS,
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How NCV testing works• - I measure the distance between 2 stimulation points, in
millimeters, with my $1.95 tape measure• - The $20,000 machine measures the time, in milliseconds, it
takes the nerve to transmit the signal between the two stimulation points
• - Voila! Distance/time, like miles/hours, tells the speed (conduction velocity) of the nerves. Nerves travel slower if pinched (at the elbow), compressed (in the Carpal Tunnel), damaged (neuropathies like Guillain-Barre, Diabetes, Alcohol)
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Correct!
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Incorrect!
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Coding
• Straightforward – it’s based on the total number of nerves examined:
• 1-2 nerves: 95907• 3-4 nerves: 95908• 5-6 nerves: 95909• 7-8 nerves: 95910• 9-10 nerves: 95911• 11-12 nerves: 95912
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EMG = Electromyography
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Electromyography
• Doesn’t directly measure the nerves, but instead directly measures the electrical activity of the muscle fibers themselves
• Useful to detect pinched nerves in the neck or back, muscle diseases like muscular dystrophy or myopathies
• Will be abnormal if the nerve supplying the muscle examined is severely damaged, like a bad carpal tunnel syndrome, severe neuropathy, sciatica, Lou Gehrig’s disease, etc…
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Continued:
• -There are no electric shocks involved• - 28-30 gauge needle that’s coated in Teflon,
with the last millimeter bare metal. It works a lot like a phonograph needle
• For many people, the EMG part of the exam is less irritating than the NCV test
• Can tell if a pinched nerve is new, old, or both
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No, it’s not torture either!
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EMG
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Need to know your muscles!
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…and the nerves that connect them
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EMG Coding
• 2 Determinants:
• 1. Is an NCV study also performed?
• 2. Is it a limited study (5 or fewer muscles examined) or not (more than 5 muscles)
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Done by itself, with no NCV study:
• -Limited study: 95870
• -Full limb:– 1 limb: 95860– 2 limbs: 95861– 3 limbs: 95863– 4 limbs: 95864
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“Add On” with NCV study:
- Limited: 95885
- 1 Extremity: 95886 (modified by the number of limbs examined)
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Less Common Codes
95887: EMG of a non-extremity add on to NCV- facial muscles in Bell’s Palsy-paraspinal muscles
95874: Guided Nerve Destruction, Needle EMG- used in directing Botox injections for spasticity
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Bonus TalkThe Neurologic Exam - Gait
• 1. Normal• 2. Footdrop• 3. Hemi-paretic• 4. Parkinsonian – Hemi, Bilateral• 5. Hyperkinetic• 6. Orthopedic• 7. Trendelenberg• 8. Vestibular• 9. Alcoholic-Cerebellar• 10. Senile – anteropulsion/retropulsion• 11. Astasia-abasia• 12.Romberg
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