Needle Electromyography (EMG)
DESCRIPTION
Needle electromyography (i.e., conventional EMG) is performed to exclude, diagnose, describe and follow diseases of the peripheral nervous system and muscle, and is performed as part of an electrodiagnostic evaluation. Needle EMGs should be performed by physicians only. (i.e., MD, DO, or Chiropractic Neurologist).
Needle EMG refers to the recording and study of electrical activity of muscle using a needle electrode. EMG assesses the integrity of lower motor neurons, neuromuscular junction and the muscle itself. It is performed as a complementary component of an electrodiagnostic evaluation. The needle electrode allows for interpretation of the muscle’s electrical characteristics at rest and during activity and is synthesized with the history, physical and NCS results.
The needle EMG exam is the gold standard in diagnosing radiculopathies. In fact, the diagnosis of cervical, thoracic, lumbar, or lumbosacral radiculopathy cannot be made without Needle EMG (though it may be in conjunction with anatomic imaging studies such as MRI, CT, or myelography). Other diagnoses in which Needle EMG is of critical importance include:
Peripheral Nerve Entrapments (e.g. Carpal Tunnel Syndrome, Ulnar Neuropathy, Peroneal/Fibular Neuropathy)
Peripheral Nerve Injuries
Myopathies and Muscular Dystrophies
Neuromuscular Junction Disorders (e.g. Myaesthenia Gravis)
Motor Neuron Disease (e.g. Amyotrophic Lateral Sclerosis)
Generalized Peripheral Neuropathy (e.g. Diabetic Neuropathy, Alcoholic Neuropathy, Hereditary Neuropathies)
Dissociation of Nerve Conduction Studies (NCS) and the EMG into separate reports is generally inappropriate. Performance and interpretation of NCS separately from the needle EMG component of the test should be the exception (e.g. when testing an acute nerve injury or when the individual is on anticoagulants) rather than the established practice pattern.
[NOTE: Devices available for point-of-care testing have been developed for office based testing. These have preconfigured electrodes intended for testing very specific nerves. Although they may use the term EMG in their manufactured name (e.g., ADVANCE™ NCS/EMG by NEUROMetrix®) they evaluate nerve conduction and are not a conventional EMG. These automated NCS systems are not addressed on this policy]
POLICY
Needle electromyography to confirm diseases of the peripheral nervous system and muscle is considered medically necessary.
Needle electromyography as a component of the biofeedback treatment of conditions is considered investigational.
See also:
IMPORTANT REMINDERS
ADDITIONAL INFORMATION
In order to perform and interpret electrodiagnostic tests, BCBST concurs with the position of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) that, the EDX consultant be a physician clinician who has had 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.
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.
No controlled studies were found in the reviewed published literature that validated the use of needle electromyography in the evaluation or treatment of conditions for biofeedback purposes.
SOURCES
Agency for Healthcare Research and Quality. (2009). Prevention of urinary and fecal incontinence in adults. Retrieved April 17, 2012 from http://www.ahrq.gov/downloads/pub/evidence/pdf/fuiad/fuiad.pdf.
American Association of Neuromuscular & Electrodiagnostic Medicine. (2010). Recommended policy for electrodiagnostic medicine. Retrieved April 17, 2012 http://www.aanem.org/getmedia/6513fe50-8b94-4d12-b6a9-249aca7cdb92/Recommended_Policy_EDX_Medicine_062810.pdf.aspx.
American College of Occupational and Environmental Medicine, (2007). Low back disorders. Retrieved July 23, 2010 from http://www.guideline.gov.
BlueCross Blue Shield Association. Medical Policy Reference Manual. (10:2011). Biofeedback as a treatment of fecal incontinence. (2.01.64). Retrieved April 17, 2012 from BlueWeb. (22 articles and/or guidelines reviewed)
BlueCross Blue Shield Association. Medical Policy Reference Manual. (7:2011). Biofeedback as a treatment of urinary incontinence in adults. (2.01.27). Retrieved April 17, 2012 from BlueWeb. (17 articles and/or guidelines reviewed)
Complete Guide to Medicare Coverage Issues [Computer software]. (2011, November). Biofeedback therapy (NCD 30.1, p. 2-30). Ingenix.
National Institute for Health and Clinical Excellence. (2006). Urinary incontinence. Retrieved April 19, 2012 from http://www.nice.org.uk/nicemedia/live/10996/30279/30279.pdf.
U.S. Food and Drug Administration. (2007, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071185. Retrieved August 9, 2010, from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K071185.pdf.
U.S. Food and Drug Administration. (2008, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K080914. Retrieved August 9, 2010, from http://www.accessdata.fda.gov/cdrh_docs/pdf8/K080914.pdf.
Wisconsin Physician Services. (2011). LCD Neuro-005 Nerve conduction studies and electromyography. Retrieved April 17, 2012 from http://www.cms.gov/medicare-coverage-database/lcd_attachments/31346_6/L31346_NEURO005_CBG_010112.pdf.
ORIGINAL EFFECTIVE DATE: 4/1981
MOST RECENT REVIEW DATE: 5/10/2012
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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