Telemedicine Transmission of Electroencephalograms (EEGs)
DESCRIPTION
An electroencephalogram (EEG) is a test that measures and records the electrical activity of the nerve cells in the brain. Electrode sensors placed on the skull detect the electrical impulses which are then amplified and converted into wave patterns for interpretation. Variations in wave patterns correlate with neurological conditions and may be used to diagnose conditions.
Telephone, radio or cable can transmit EEGs with recorded electrical brain activity to an off-site center for interpretations and report. Use of this technology in the absence of a local neurologist can prevent treatment delay by enabling a remote neurologist to provide EEG review services in collaboration with the treating physician.
POLICY
Telephone transmission of EEGs is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Radio and cable telemetry of EEGs are considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Telephone transmission of EEGs to determine electrocerebral silence (i.e., brain death) is considered investigational.
MEDICAL APPROPRIATENESS
Telemedicine transmission of electroencephalograms (EEG) is considered medically appropriate if ANY ONE of the following criteria are met:
Telephone transmission of EEGs if ALL of the following criteria are met:
The closest medical facility is remotely located and lacks trained EEG interpreters
ANY ONE of the following:
For altered consciousness (e.g., such as stuporous, semicomatose, or comatose states)
For atypical seizure variants in an individual experiencing bizarre, distressing symptoms as seen with "spike and save stupor" or other forms of seizure disorders
For head injury, where a subdural hematoma may be identified
For differentiation of complicated migraine with epilepsy-like symptoms (e.g., auras, alteration in level of consciousness) from true seizure disorder
Radio and cable telemetry transmissions of EEGs if ALL of the following are met:
The closest medical facility is remotely located and lacks trained EEG interpreters
ANY ONE of the following:
For EEG recording during provocation testing (e.g., withdrawal of anticonvulsant medications), which can be safely undertaken only in the immediate proximity of emergency medical personnel and technology
For EEG recording attempting to localize the seizure focus prior to surgery when ambulation is desirable (e.g., when seizures are triggered by specific environmental stimuli or daily events)
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Telemedicine and telehealth both describe the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. Telemedicine is sometimes associated with direct patient clinical services and telehealth with a broader definition of remote healthcare services.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2004). Electroencephalograms (EEG) (2.01.14). Retrieved July 28, 2009 from BlueWeb.
Breen, P., Murphy, K., Browne, G., Molloy, F., Reid, V., Doherty, C. et al. (2010). Formative evaluation of a telemedicine model for delivering clinical neurophysiology services part I: Utility, technical performance and service provider perspective. BMC Medical Informatics and Decision Making, 10 (48), 1-16. (Level of Evidence 3 - Independent)
Complete Guide to Medicare Coverage Issues [Computer software]. (2009, April). Telephone transmission of electroencephalograms (NCD 160.21, p. 2-80). The Ingenix Complete Guide to Medicare Coverage Issues.
National Guideline Clearinghouse. Scottish Intercollegiate Guidelines Network (SIGN). (2009, May). Diagnosis and management of epilepsy in adults. Update to printed guideline. Retrieved June 29, 2009 from http://www.guidelines.gov.
Nizam Ahmed, S., Mann, C., Siddiqui, F., Sheerani, M., Ali Syed, N., Snyder, T., et al. (2009). Experiences from an international tele-epilepsy collaboration. Canadian Journal of Neurological Science, 36 (5), 582-586. (Level of Evidence 4 - Industry supported)
Tennessee Code: Title 68: Health, Safety and Environmental Protection: Chapter 49 Epilepsy and Seizure Disorders: 68-49-101-103. Care and treatment program. Retrieved July 29, 2009 from http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.
ORIGINAL EFFECTIVE DATE: 7/1982
MOST RECENT REVIEW DATE: 9/29/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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