BlueCross BlueShield of Tennessee Medical Policy Manual

Electromyography and Nerve Conduction Studies (Electrodiagnostic Assessment)

DESCRIPTION

Electromyography (EMG) and nerve conduction studies (NCS), collectively known as electrodiagnostic (EDX) assessment, are intended to evaluate the electrical functioning of muscles and peripheral nerves.  These tests are used as diagnostic aids for the evaluation of myopathy and peripheral neuropathy by identifying, localizing and characterizing electrical abnormalities in the skeletal muscles and peripheral nerves.   These tests are performed when there is a clinical suspicion for a myopathic or neuropathic process and when clinical examination and standard laboratory testing are unable to make a definitive diagnosis.  The results of these tests do not generally provide a specific diagnosis; however, they provide additional information that assists the physician in characterizing a clinical syndrome.

Nerve conduction studies performed without needle EMG may be missing valuable data that could be essential to determine an accurate diagnosis. Dissociation of Nerve Conduction Studies (NCS) and the EMG into separate reports is generally inappropriate.

POLICY

See also:

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

It is the position of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) that electrodiagnostic (EDX) evaluations must be performed by physicians who have comprehensive knowledge of neurological and musculoskeletal disorders to assure accurate interpretation and diagnosis, and to provide patients with quality care.  The typical EDX evaluation involves: a focused neuromuscular history and physical examination, the development of a differential diagnosis, the examination of muscles and nerves utilizing nerve conduction studies and needle electromyography, and the determination of a final diagnosis.  The standard of care in clinical practice dictates that each of these components cannot be predetermined or standardized.  Once the preliminary differential diagnosis has been determined, a technician may perform the nerve conduction studies (NCS) that were selected by the physician. 

BCBST concurs with the position of AANEM that the physician performing EDX has received special training in the diagnosis and treatment of neurological and neuromuscular diseases and in the application of particular neurophysiologic techniques to the study of these disorders. This type of training is generally included in the residency or fellowship programs of physicians who specialize in physical medicine and rehabilitation (physiatrists) or neurology (neurologists). This specialized training is comprehensive including presentation of didactic materials by an experienced EDX consultant, a lengthy preceptorship under the supervision of an experienced EDX consultant, and the completion of a specified number of EDX evaluations (general 200 or more). BCBST does not recognize 2-3 day training courses (e.g. Vendor/manufacturer/distributor provided training, device specific training, week-end workshops, DVD training) as meeting the standards for specialized training in the field of EDX.

The technician performing NCS under the physician’s supervision, must be trained in electrodiagnostic testing and licensed or certified by the state (or by one of the state's health related boards if licensure or certification as a technician does not exist in a given state) in which the studies are performed.

BCBST agrees with the current interpretation of the Committee on Electrodiagnosis of the American Chiropractic Association Council on Neurology that electrodiagnostic evaluation/interpretation in the assessment of neurological disorders should be performed by a board eligible or board certified Chiropractic Neurologist.

Published scientific evidence in peer-reviewed journals regarding the utilization of automated, non-invasive nerve conduction equipment for diagnosis of disease of the peripheral nervous system is lacking.

SOURCES

American Academy of Neurology (2004) Position statement: Diagnostic electromyography is the practice of medicine. Retrieved October 19, 2015 from: www.aan.com.

American Academy of Neurology. (2016). Practice guideline update summary: Botulinum Neurotoxin for the Treatment of Blepharospasm, Cervical Dystonia, Adult Spasticity and Headache. Retrieved September 16, 2016 from https://www.aan.com/Guidelines/Home/ByTopic?topicId=17.

American Association of Electrodiagnostic Medicine. (2003, January). Consensus criteria for the diagnosis of multifocal motor neuropathy. Retrieved September 14, 2016 from https://www.aanem.org/getmedia/afd29b39-2179-421e-bac7-f88b4294a27d/CCDiagoseMMN.pdf.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2014, August). Recommended policy for electrodiagnostic medicine. Retrieved September 14, 2016 from https://www.aanem.org/getmedia/ed2143b6-917f-4218-b699-e682b18ad15d/2014_Recommended_Policy_EDX_Medicine-(1).pdf.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2011, January). Position statement on neuromuscular medicine qualifications. Retrieved March 13, 2014 from http://aanem.org.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2016, January). Model policy for needle electromyography and nerve conduction studies. Retrieved September 15, 2016 from https://www.aanem.org/getmedia/65934187-d91e-4336-9f3c-50522449e565/Model-Policy.pdf.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2012). Who is qualified to practice electrodiagnostic medicine? Retrieved March 13, 2014 from http://www.aanem.org.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2014). Risks in electrodiagnostic medicine. Retrieved September 15, 2016 from https://www.aanem.org.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2015). Common indicators suggesting fraud & abuse in electrodiagnostic medicine. Retrieved September 14, 2016 from https://www.aanem.org.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2015). Mobile electrodiagnostic laboratories provide substandard patient care. Retrieved September 14, 2016 from https://www.aanem.org/getmedia/21cc5d73-3d9f-4240-b780-5acd2f6eb15f/Position-Statement_Mobile-Electrodiagnostic-Laboratories.pdf.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2014). Proper performance and interpretation of electrodiagnostic studies. Retrieved September 14, 2016 from https://www.aanem.org/getmedia/bd1642ce-ec01-4271-8097-81e6e5752042/Position-Statement_Proper-Performance-of-EDX_-2014.pdf.aspx.

American Association of Neuromuscular & Electrodiagnostic Medicine. (2014). Common referral indications for electrodiagnostic medicine evaluations. Retrieved September 14, 2016 from https://www.aanem.org/getmedia/d4fddaaa-58bc-491c-a7a9-cd006ae68ee5/Common-referral-indication.pdf.

American Chiropractic Association. (2014). ACA Neurology Council to offer accredited certification in electrodiagnostics. Retrieved March 14, 2014 from http://www.acatoday.org.

BlueCross BlueShield Association. Medical Policy Reference Manual. (8:2017). Automated point-of-care nerve conduction tests (2.01.77). Retrieved October 17, 2017 from BlueWeb. (27 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (7:2017). Electromyography and nerve conduction studies. (2.01.95). Retrieved October 17, 2017 from BlueWeb. (24 articles and/or guidelines reviewed)

Cahaba Government Benefit Administrators®, LLC (2017, October) Local Coverage Determination (LCD): Nerve conduction studies (NCS) and electromyography (EMG) (L34265). Retrieved October 17, 2017 from https://www.cms.gov.

Chan, A.K., Finlayson, H., & Mills, P.B. (2016). Does the method of botulinum neurotoxin injection for limb spasticity affect outcomes? A systematic review. Clinical Rehabilitation, 2016 Jul 1. Pii:0269215516655589 [epub ahead of print]. Abstract retrieved September 15, 2016 from PubMed database.

Grigoriu, A.I., Dinomais, M., Rémy-Néris, O., & Brochard, S. (2015). Impact of injection-guiding techniques on the effectiveness of botulinum toxin for the treatment of focal spasticity and dystonia: a systematic review. Archives of Physical Medicine and Rehabilitation, 96 (11), 2067-2078. (Level 1 evidence)

Katirji, B. (2012). Bradley’s Neurology in Clinical Practice Neurological Investigations and Clinical Neurosciences. (6th edition, p394-420). Philadelphia, PA: Elsevier.

Kim, J., Lee, G., and Kwon, J. (2014, December) Development of a nerve conduction technique for the recurrent laryngeal nerve. Laryngoscope, 124 (12), 2779-84. Abstract retrieved October 17, 2017 from PubMed database.

Ploumis, A., Varvarousis, D., Konitsiotis, S., & Beris, A. (2014). Effectiveness of botulinum toxin injection with and without needle electromyographic guidance for the treatment of spasticity in hemiplegic patients: a randomized controlled trial. Disability and Rehabilitation, 36 (4), 313-318. Abstract retrieved September 15, 2016 from PubMed database.

U. S. Food and Drug Administration. (2003, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070109. Retrieved September 21, 2010 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2003, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K060584. Retrieved September 21, 2010 from: http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2011, March). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K102610. Retrieved March 13. 2014 from http://www.accessdata.fda.gov.  

Winifred S. Hayes, Inc. Search & Summary (2017, September) Electromyogram (EMG) and preoperative diagnosis of carpal tunnel syndrome. Retrieved October 17, 2017 from www.hayesinc.com (6 articles and/or guidelines reviewed)

Wu, C., Xue, F., Chang, W., Lian, Y., Zheng, Y., Xie,N., et al. (2016). Botulinum toxin type A with or without needle electromyographic guidance in patients with cervical dystonia. SpringerPlus, 2016, 5:1292. DOI 10.1186/s40064-016-2967-x. (Level 2 evidence)

ORIGINAL EFFECTIVE DATE:  4/1981

MOST RECENT REVIEW DATE:  12/14/2017

ID_BT

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