American Association of Neuromuscular & Electrodiagnostic Medicine
American Academy of Neurology
American Academy of Physical Medicine and Rehabilitation

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Executive Summary

The electrodiagnostic medicine (EDX) consultation is an important and useful extension of the clinical evaluation of patients with disorders of the peripheral and/or central nervous system. EDX tests are often crucial to evaluating symptoms, arriving at a proper diagnosis, and in following a disease process and its response to treatment in patients with neuromuscular disorders. Unfortunately, EDX studies are poorly understood by many in the medical and lay communities. Even more unfortunate, these studies have occasionally been abused by some providers, resulting in overutilization and inappropriate consumption of scarce health resources. The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM [formerly AAEM]) has developed this model policy to improve the quality of patient care, to encourage appropriate utilization of the procedures involved, and to assist Medicare Carrier Advisory Committees and other insurance carriers in developing policy regarding EDX testing. This document contains recommendations which can be used in developing and revising current reimbursement guidelines.

This document is based on the AANEM’s publication, The Electrodiagnostic Medicine Consultation, and was further refined by consensus at a conference of 43 experts in the field of electrodiagnostic medicine held on April 8, 1994, in Chicago, Illinois. This consensus conference was held to produce guidelines that could be used to identify overutilization. Participants in the conference represented a diversity of practice types and were either neurologists or physiatrists and included the AANEM Board of Directors, committee chairs, Professional Practice Committee members, and other members of the association. Physicians from both academic medical centers and private practice were represented. With the help of the AANEM Professional Practice Committee, the guidelines have continuously been expanded to produce this comprehensive policy regarding the optimal use of EDX procedures.

This document provides:

1. An introduction to the mission of the AANEM.
2. An overview of the scope of electrodiagnostic medicine.
3. Indications for the performance of EDX testing.
4. A list of applicable American Medical Association Current Procedural Terminology (CPT™) codes.
5. A recommended source for a list of ICD-9-CM diagnosis codes that are acceptable indications for needle electromyography (EMG) and nerve conduction procedures.
6. An overview of nerve conduction studies (NCSs).
7. An overview of needle EMG.
8. An overview of late responses, including H-reflex and F-wave studies.
9. An overview of blink reflexes.
10. An overview of neuromuscular junction (NMJ) studies.
11. An overview of somatosensory evoked potentials (SEPs).
12. An overview of autonomic nervous system function testing.
13. A recommended maximum number of EDX studies necessary for certain diagnostic categories in 90% of cases.
14. Information regarding the timing of EDX testing after an injury.
15. Recommended reasonable limits on the frequency of EDX testing in individual patients.
16. Recommended minimum standards for EDX testing that must be met under this policy.
17. A list of nerves to assist in coding for nerve conduction studies.

Recognizing the critical need for testing individualized to the patient’s condition, it is necessary that physicians have flexibility to design and carry out the appropriate EDX studies. However, the peer-review mechanism should be triggered when patterns of electrodiagnostic test utilization significantly and consistently deviate from established norms for numbers and types of procedures. Individuals may obtain the names of American Board of Electrodiagnostic Medicine (ABEM) certified physicians from the ABEM directory found on the ABEM website at www.abemexam.org. These physicians can be contacted to review questionable cases, assist in the review process, and advise on claims that appear to be unusually excessive.

The American Association of Neuromuscular & Electrodiagnostic Medicine

Founded in 1953 and currently numbering over 4900 physicians, primarily neurologists and physiatrists, the AANEM is the largest organization worldwide dedicated solely to the scientifically based advancement of neuromuscular medicine. The primary goal of the AANEM is to increase the quality of patient care, specifically for those patients with disorders of the central and peripheral nervous systems, the neuromuscular junction, and skeletal muscle by contributing to steady improvement in the methods of diagnosing and treating patients with disorders of muscle and nerve. This goal is accomplished through programs in education, research, and quality assurance.

The AANEM publishes a wide range of educational material and sponsors annual didactic programs, symposia, courses, and workshops. The AANEM informs its members about both basic and clinical research activities in electrodiagnostic medicine and neuromuscular diseases through its annual meeting sessions, the journal Muscle & Nerve, videotapes, monographs, case reports, and other educational material. In so doing, the AANEM fosters the conduct of and enhances the quality of this research. The AANEM also offers a Training Program Self-Assessment Examination annually. This examination is an educational tool which is often used by training programs for their residents, fellows, and faculty members. The examination offers an opportunity for individuals to assess their knowledge of electrodiagnostic medicine.

The American Board of Electrodiagnostic Medicine is an independent credentialing body in electrodiagnostic medicine. Although it is organized and operated as a committee of the AANEM, it is completely autonomous for purposes of credentialing criteria and procedures. The ABEM’s goal is to enhance the quality of patient care through a voluntary certification process and thereby serve the public interest. The ABEM holds an annual examination through which candidates are able to assess their level of competence.

The ABEM established a maintenance of certification program to provide a mechanism for ABEM Diplomates to demonstrate their continuing education in electrodiagnostic medicine as they keep up-to-date with this medical specialty. Diplomates are expected to demonstrate current medical knowledge and clinical problem-solving skills in periodic recertification examinations. Certification is limited to 10 years. The first time-limited certificates were issued in 1994.

The AANEM is committed to the development of medically sound and clinically relevant guidelines for electrodiagnostic medicine. This is accomplished through literature review, expert opinion, and consensus of AANEM leaders and committee members, as well as input from the general membership and other experts in the field. The AANEM has published Somatosensory Evoked Potentials: Clinical Uses and Guidelines in Somatosensory Evoked Potentials, and specific guidelines on median nerve entrapment at the wrist (carpal tunnel syndrome) are included in the AANEM’s Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome. The AANEM’s Practice Parameter for Electrodiagnostic Studies in Ulnar Neuropathy at the Elbow provides specific guidelines on nerve compression in the region of the elbow. The AANEM’s Practice Parameter for Needle Electromyographic Evaluation of Patients With Suspected Cervical Radiculopathy provides specific guidelines of the needle EMG examination for patients with suspected cervical radiculopathy. The AANEM has also published papers on myasthenia gravis, laryngeal EMG, multifocal motor neuropathy, and many more. (Documents mentioned in this paragraph are available through the AANEM Executive Office for a small fee.)

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