Somatosensory Evoked Potentials (Non-intraoperative)
DESCRIPTION
Somatosensory evoked potentials (SEPs) are one type of evoked potential (EP) which are generated by stimulation of afferent peripheral nerve fibers elicited by electrical, tactile, or other stimuli. By following mixed nerve or sensory nerve stimulation, SEPs can be recorded over more proximal portions of the peripheral and central nervous system including peripheral nerves, spinal cord, and/or brain. By stimulating the skin in various dermatomal areas, an SEP may also be recorded (dermatomal somatosensory evoked potential or DSEP).
SEPs may be used to assess the functional integrity of the central and peripheral sensory pathways. These are noninvasive studies performed by repetitive submaximal stimulation of a sensory or mixed sensorimotor peripheral nerve and recording averaged responses from electrodes placed over proximal portions of the nerve stimulated, plexus, spine, and scalp. Amplitude, peak, and interpeak latency measurements with side-to-side comparisons are used to assess abnormalities.
POLICY
Somatosensory evoked potentials in the diagnosis of the diseases/conditions listed under Medical Appropriateness are considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Somatosensory evoked potentials in the diagnosis of other diseases/conditions, including, but not limited to, the following are considered investigational:
Acute radiculopathies (e.g., acute lumbosacral radiculopathy), thoracic root disorders and cervical root diseases. These are diseases/conditions of the ventral rootlets and roots; and
Acute inflammatory demyelinating polyradiculoneuropathy (AIDP), focal neuropathy (including entrapment neuropathies, carpal tunnel syndrome, lateral femoral cutaneous neuropathy, medial and lateral plantar neuropathy, saphenous neuropathy, intercostal neuropathy, trigeminal neuropathy and plexopathy). These are diseases/conditions of the peripheral nervous system.
See also:
MEDICAL APPROPRIATENESS
Somatosensory evoked potentials are considered medically appropriate for all of the following diseases/conditions:
Diseases/conditions of the brain and brainstem (e.g., multiple sclerosis, diseases of myelin [e.g., adrenoleukodystrophy, adrenomyeloneuropathy], hereditary system degenerations [e.g., Friedreich's ataxia], myoclonus, coma); and
Diseases/conditions of the spinal cord (e.g., spinal cord trauma, vitamin B12 deficiency, cervical spondylosis and myelopathy, syringomyelia, hereditary spastic paraplegia, metabolic disorders [chronic renal failure and juvenile diabetes], transverse myelitis and multiple sclerosis, vascular lesions, spinal cord tumors, myelomeningocele, tethered cord syndrome); and
Lumbosacral spinal stenosis resulting in chronic compression, a disease/condition of the ventral rootlets and roots, as evidenced by CT, MRI or myelogram; and
Hereditary neuropathies, diabetic neuropathy, inflammatory polyradiculoneuropathies, infectious disorders and toxic neuropathies. These are diseases/conditions of the peripheral nervous system.
ADDITIONAL INFORMATION
BlueCross BlueShield of Tennessee has adopted the position of the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) in regard to the investigational uses of sensory evoked potentials (SEPs).
Somatosensory evoked potentials do not meet the following technology evaluation criteria:
The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes.
The technology must improve the net health outcome.
The technology must be as beneficial as any established alternatives.
The improvement must be attainable outside the investigational settings.
The decision to perform an SEP must be based upon a history and physical examination findings obtained prior to the performance of the procedure and evident in the individual's record.
As specified by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), evoked potential (EP) records should contain the following information:
The individual's name, identifying number (if applicable), age, and gender.
The date of examination.
The technologist's name or initials, as well as the name of the physician who interpreted the studies.
The derivation recorded in each channel in the form of abbreviated accepted designations of the electrode locations connected to the input terminals 1 and 2 of the amplifier, in that order.
The type, intensity, and rate of presentation of the stimuli, and the side and site of stimulation.
Other information relative to test results, including the nerve stimulated and the side.
The number of individual trials averaged.
The time calibration, corresponding to the epoch averaged, with subdivisions appropriate to the temporal dimensions of the EP recorded. Whenever a pre-stimulus baseline or post-stimulus delay is used, it should be clearly displayed.
The voltage calibration indicating the amplitude of deflection produced in terms of sensitivity (voltage/linear distance).
Modern EP equipment will leave marks indicating the points at which "measurements" were taken. If such features are not available, the technologist or physician must mark by hand the peaks recognized and the sites at which they were measured.
The physician performing SEPs must be trained or certified in the application, performance and interpretation of electrodiagnostic testing and licensed by the state in which the studies are performed. The technician delegated to perform SEPs 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. See also: Staff Supervision Requirements for Delegated Services.
According to the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), becoming credentialed by a national examining organization that assesses accuracy of knowledge of EPs is the only objective method of demonstrating competency in the interpretation of EP studies. Eligibility requirements for the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) examination include completion of an accredited residency in neurology or physical medicine and rehabilitation with a minimum of six months of full-time equivalent formal clinical neurophysiology training. Another requirement is Board certification by the American Board of Psychiatry and Neurology (neurology or psychiatry) or the American Board of Physical Medicine and Rehabilitation (physiatry). One year of additional post-residency experience is also required. Current interpretation of the Committee on Electrodiagnosis of the American Chiropractic Association Council on Neurology is that electrodiagnostic evaluation/interpretation in the assessment of neurological disorders should be performed by a board eligible or board certified Chiropractic Neurologist.
According to the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM), a written and signed interpretation must be provided for each clinical EP study. The interpretation should begin with the object of the examination and a concise summary of the clinical history available at the time of recording. The type of EP recorded should be briefly outlined and information provided on any relevant medications received by the patient either as a treatment or in preparation for the test. The results of relevant ancillary tests should also be presented. Copies of the waveforms recorded should be included or made available upon request.
SOURCES
American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). (2002, last update). Recommended policy for electrodiagnostic medicine (Endorsed by the American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation and the American Association of Neuromuscular & Electrodiagnostic Medicine). Retrieved October 2, 2006 from http://www.aanem.org/documents/recpolicy.pdf.
American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Guidelines in Electrodiagnostic Medicine. (1999). Chapter 5: Somatosensory Evoked Potentials: Clinical Uses. Muscle Nerve, 22 (Supplement 8), S111-S118.
American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Guidelines in Electrodiagnostic Medicine. (1999). Chapter 6: Guidelines in somatosensory evoked potentials. Muscle Nerve, 22 (Supplement 8), S123-S138.
American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Position Statement. (1999). Who is qualified to practice electrodiagnostic medicine? Muscle Nerve, 22 (Supplement 8), S263-S265. Retrieved October 2, 2006 from http://www.aanem.org/documents/who_is_qualified.pdf.
American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Position Statement. (1999). Responsibilities of an electrodiagnostic technologist. Muscle Nerve, 22 (Supplement 8), S17-S18. Retrieved October 2, 2006 http://www.aanem.org/practiceissues/positionstatements/responsibilities_of_an_EDXTech.cfm.
American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Position Statement. (2000). Job description for electrodiagnostic technologists. Retrieved October 2, 2006 from http://www.aanem.org/practiceissues/positionstatements/job_descriptions_for_edxtech.cfm.
American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Position Statement. (1999). Technologists conducting nerve conduction studies and somatosensory evoked potential studies independently to be reviewed by a physician at a later time. Muscle Nerve, 22 (Supplement 8), S266. Retrieved October 2, 2006 from http://www.aanem.org/practiceissues/positionstatements/TechsNCSSEP.cfm.
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EFFECTIVE DATE |
12/14/2006 |
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