BlueCross BlueShield of Tennessee Medical Policy Manual

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

See also:

IMPORTANT REMINDERS

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).

Well-designed studies in peer-reviewed journals, which evaluate the clinical importance of somatosensory evoked potentials for conditions listed above as investigational, are lacking.

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 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

Amatini, A., Amadori, A., & Fossi, S.  (2008). Evoked potentials in the ICU. European Journal of Anaesthesiology, 25 (42), 196-202.

American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). (Endorsed by the American Academy of Neurology, the American Academy of Physical Medicine and Rehabilitation and the American Association of Neuromuscular & Electrodiagnostic Medicine). Recommended policy for electrodiagnostic medicine. Retrieved May 15, 2012 from http://www.aanem.org/getmedia/6513fe50-8b94-4d12-b6a9-.249aca7cdb92/Recommended_Policy_EDX_Medicine_062810.pdf.aspx.

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). (1999). Position Statement. Who is qualified to practice electrodiagnostic medicine? Retrieved May 15, 2012 from http://www.aanem.org/getmedia/470fb367-ee3b-473b-8575-2af659695691/ed_gl_for_edx_tp.PDF.aspx.

American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). (1999). Position Statement. Responsibilities of an electrodiagnostic technologist. Retrieved May 15, 2012 http://www.aanem.org/getmedia/527e4fd3-f0eb-49ed-8545-1be4071c4e4d/responsibilities_of_edx_techs.PDF.aspx.

American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). Position Statement. (2000). Job description for electrodiagnostic technologists. Retrieved May 15, 2012 from http://www.aanem.org/getmedia/ac5225c9-9818-40e7-a49c-38c84c1858e7/job_descriptions_edx_techs.PDF.aspx.

American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM). (2009). Position Statement.  Technologists conducting nerve conduction studies and somatosensory evoked potential studies independently to be reviewed by a physician at a later time. Retrieved May 15, 2012 from http://www.aanem.org/getmedia/0ecf23a8-1e4e-41a0-b244-b818e3af5333/TechsNCSSEP062509.pdf.aspx.

American Clinical Neurophysiology Society. (2008). Guideline 9A. Guideline on evoked potentials. Retrieved May 15, 2012 from http://www.acns.org/pdfs/ACFDFD0.pdf.

American Clinical Neurophysiology Society. (2008). Guideline 9D. Standards for short latency somatosensory evoked potentials. Retrieved May 15, 2012 from http://www.acns.org/pdfs/Guideline%209D.pdf.

Complete Guide to Medicare Coverage Issues [Computer software]. (2012, April). Evoked response tests.  (NCD 160.10, p. 2-74). Ingenix.

Cruccu, G., Aminoff, M., Curio, G., Guerit, J., Kakigi, R., Mauguiere, F., et al. (2008). Recommendations for clinical use of somatosensory evoked potentials. Clinical Neurophysiology, 119 (2008), 1705-1719.

U. S. Food and Drug Administration. (2009. December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K083371. Retrieved May 16, 2012 http://www.accessdata.fda.gov/cdrh_docs/pdf8/K083371.pdf.

ORIGINAL EFFECTIVE DATE:  7/1982

MOST RECENT REVIEW DATE:  8/9/2012

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