Neurometer CPT Sensory Nerve Conduction Threshold (snct ) Electrodiagnostic Evaluation

Transcription

1 Neurometer CPT Sensory Nerve Conduction Threshold (snct ) Electrodiagnostic Evaluation Overview and References Appendix C. Utilization Guidelines By Medical Specialty Contents Appendix C. Utilization Guidelines By Medical Specialty...C - 1 Endocrinology...C - 3 Family Practice/Internal Medicine...C - 3 Nephrology...C - 3 Neurology...C - 4 Neurosurgery...C - 4 Oncology...C - 5 Orthopedic Surgery...C - 5 Pain Management...C - 5 Physical Medicine and Rehabilitation...C - 5 Podiatry...C - 5 Rheumatology...C - 6 Urology...C - 6 Chiropractic...C - 6 Physical/Occupational Therapy...C - 6 NEUROTRON, INCORPORATED I N N O V A T I V E M E D I C A L T E C H N O L O G Y USA

2 THIS NEEDS TO BE BROUGHT UP TO DATE WITH THE WEBSITE The following list presents guidelines for the reasonable and appropriate use of the snct/cpt electrodiagnostic procedure within specific medical specialties. Electrodiagnostic testing is considered to be a dynamic process however, therefore the results of any single test in a planned series may determine whether any additional testing is indicated. Neurometer Endocrinology Endocrinologists primarily use snct/cpt studies to objectively evaluate the impact of diabetic and pre-diabetic conditions to monitor and guide their patient s medical management. The Neurometer CPT evaluation is prescribed by the endocrinologist when clinical examination findings are equivocal or suggest the development of an impairment in distal sensory function and an objective evaluation is required to confirm and evaluate a diagnosis of polyneuropathy. Typically, the distal great toe test site is tested bilaterally and if a polyneuropathy is detected then therapeutic interventions or modifications may be considered to attempt to reverse the condition and/or prevent its progression. Normal CPT evaluation results indicate that no further CPT testing is necessary unless a change in the clinical condition or laboratory findings suggesting sensory dysfunction requires an evaluation. Family Practice/Internal Medicine The primary care provider performs snct/cpt studies to assist in the differential diagnosis of polyneuropathy, compressive/focal neuropathy and radiculopathy. This electrodiagnostic study is only administered when clinical findings suggest a sensory impairment requiring an objective quantitative assessment. Typically, the study is only conducted once on a patient unless there is the development of new sensory symptoms which warrant an evaluation. Nephrology Nephrologists use snct/cpt studies to evaluate patients with kidney disease to assist in determining when to commence dialysis therapy. The study is prescribed when clinical examination findings suggest development of an impairment in distal sensory function and an objective evaluation is required to confirm and evaluate a diagnosis of polyneuropathy. Typically, the distal great toe test site is tested bilaterally and if a polyneuropathy is detected then dialysis therapy may be considered to attempt to reverse the condition and/or prevent its progression. Normal snct/cpt evaluation results indicate that no further snct/cpt testing is necessary unless a change in the clinical condition suggesting sensory dysfunction requires an evaluation. Nephrologists also prescribe the snct/cpt study to be administered to endstage renal disease patients to provide an index of the long-term adequacy of dialysis therapy. Additionally, snct/cpt studies of the distal phalanges of the fingers may assist in the diagnosis of suspected Carpal Tunnel Syndrome (CTS) in dialysis patients. Fifty percent of patients receiving dialysis for six years or more develop CTS without experiencing the classical CTS symptoms due to concurrent upper extremity polyneuropathy. Left untreated, patients with CTS may suffer significant impairment of the affected hand. Neurometer snct /CPT Overview & References Neurotron, Inc., Balto., MD, USA

3 Neurology Neurometer Neurologists conduct snct/cpt studies to objectively evaluate and localize the distribution of sensory dysfunction associated with conditions, such as symmetric or asymmetric inherited and acquired sensory polyneuropathies and assist in differentiating whether they are myelinopathies or axonopathies. snct/cpt evaluations are used to objectively evaluate a suspected sensory impairment and assess disease progression and the efficacy of therapeutic intervention. Follow-up evaluations are generally only required when: 1) there is a clinical question as to whether the patients sensory pathology is deteriorating or 2) there is a clinical question as to whether the patients sensory impairment is responding to therapeutic intervention. snct/cpt studies may be prescribed for neuroselective assessment and monitoring of CNS sensory function following CNS vascular events and other types of CNS pathology (e.g. multiple sclerosis or spinal cord pathology that effects cutaneous sensory function). The snct/cpt evaluation is usually prescribed at an affected site(s) and a matched control site(s). The evaluation is not repeated unless there is a clinical suspicion of a deterioration of the patient's sensory condition requiring an objective quantitative neuroselective evaluation. snct/cpt studies may also be used to confirm or evaluate a suspected radiculopathy or focal nerve lesion, such as a carpal tunnel syndrome and assist in determining the most appropriate therapeutic intervention. Normal snct/cpt evaluation results indicate that no further snct/cpt studies are necessary unless a change in the clinical condition suggesting sensory dysfunction warrants an evaluation. Neurosurgery Neurosurgeons use snct/cpt studies to monitor return of sensation after a nerve repair. The snct/cpt evaluation may be conducted at the skin or mucosal site innervated by a repaired or transplanted nerve at approximately three month intervals following surgery to document return of sensation. snct/cpt studies are also used to evaluate radiculopathy and compressive neuropathies. Oncology Neurometer Oncologists prescribe snct/cpt studies to assess the polyneuropathy of cancer and the neurotoxic side-effects of chemotherapeutic agents to assist in developing and modifying treatment plans/goals. A clinical presentation of sensory impairment which requires an objective evaluation for polyneuropathy with testing generally conducted at the great toe test site and a cephalic test site, bilaterally. Orthopedic Surgery Orthopedic surgeons utilize snct/cpt studies to assess sensory nerve functional integrity associated with injuries resulting in sensory dysfunction (e.g. radiculopathies and focal/compressive nerve injuries). The snct/cpt evaluation is conducted to determine the severity of clinically detected sensory impairments and assist in decisions regarding surgical intervention. A new snct/cpt evaluation is only necessary if new sensory impairments develop that require an objective quantitative neuroselective evaluation. Pain Management Neurometer Patients being treated for chronic pain are administered Neurometer CPT studies when neurologic sensory signs or symptoms require an objective Neurometer snct /CPT Overview & References Neurotron, Inc., Balto., MD, USA

4 quantitative evaluation for a diagnosis or assessment of therapy. Conditions studied may include spinal cord injuries, polyneuropathies, radiculopathies, focal or compressive nerve lesions. The differential diagnosis of sensory complaints resulting from another etiology, such as soft tissue injury, sprain or strain injury, vascular insufficiency, somatic referred pain or pain of psychogenic origin, must be considered when test CPT measures are within normal limits. CPT test results within normal limits do not preclude the necessity for medical care, but are considered when establishing a basis for the differential diagnosis and subsequent treatment plan. The physician evaluating the patient with pain and allodynia who has normal CPT evaluation findings may conduct a Pain Tolerance Threshold (PTT) in order to detect pathology in the sensory nervous system transmission of pain sensation. Physical Medicine and Rehabilitation Neurometer Physiatrists have several uses for snct/cpt studies. The studies are used to evaluate suspected sensory impairments based on clinical examination findings and to assist in determining the most appropriate therapeutic intervention. Only one evaluation of the patient is generally required. snct/cpt studies may be used to quantify the severity of sensory impairment(s) secondary to brain or spinal cord injuries in rehabilitation patients, or to confirm or evaluate a suspected radiculopathy or focal peripheral nerve lesion to determine the most appropriate therapeutic intervention. snct/cpt studies are also utilized to evaluate protective sensation and other sensation in patients to assist in determination of appropriate activities of daily living. Podiatry Neurometer Podiatrists perform snct/cpt studies to assist in the differential diagnosis and quantitative evaluation of conditions resulting in sensory dysfunction in the foot such as polyneuropathy, radiculopathy, neuroma, focal nerve lesion and tarsal tunnel syndrome. Generally, two to three nerves are tested bilaterally to perform the electrodiagnostic evaluation of the foot. Once the podiatrist has treated the neuropathologic condition causing sensory dysfunction in the foot and the symptoms are resolved, no further snct/cpt studies are required for that condition. Podiatrists do not generally treat polyneuropathy or radiculopathy, so additional testing of the foot for these conditions would not be necessary and the patient would instead be referred to the appropriate health care provider. Rheumatology Rheumatologists prescribe snct/cpt studies to assess sensory impairments secondary to immunological etiology, in contrast to other causes. (e.g. focal lesions, CTS). Rheumatologists treat apparent sensory dysfunction (e.g. pain limited loss of motion with arthritis) but do not treat focal and most metabolic neuropathies. Urology Urologists utilize snct/cpt studies to assist in the differential diagnosis of neurogenic impotence. Typically, the ring finger is tested bilaterally and the penis is tested at one or two sites - the glans and the proximal dorsal shaft. Normal snct/cpt evaluation results indicate that no further testing is necessary. Recently, urologists have begun to utilize the snct/cpt Neurometer snct /CPT Overview & References Neurotron, Inc., Balto., MD, USA

5 evaluation to evaluate bladder dysfunstion. 1 Chiropractic Chiropractors use the snct/cpt evaluation to assist in the differential diagnosis and quantitative evaluation of conditions resulting in sensory dysfunction. Chiropractic patients may be administered the snct/cpt evaluation when sensory neurologic signs or symptoms are detected which require an objective quantitative evaluation for differential diagnostic and or assessment purposes. Results of the snct/cpt evaluation by be used to assist in establishing a treatment protocol or if a referral is indicated. The absence of abnormal measures indicates that no further testing is needed. The snct/cpt evaluation may be repeated to establish the outcome of therapeutic intervention and to determine maximum medical improvement. If a clinical evaluation is equivocal in determining the efficacy of therapeutic intervention with respect to the sensory symptomatology, a repeat examination may be conducted following four to six weeks of therapy. An extenuating circumstance, such as an exacerbation of an existing condition or the development of new sensory neurological impairments, may warrant a repeat snct/cpt evaluation. Physical/Occupational Therapy The snct/cpt evaluation provides the physical and occupational therapist with an objective, quantitative means to assess and document the efficacy of therapeutic intervention. 1 Ukimura, O., Iwata, T., Inaba, M., Honjo, H., Kawauchi, A., Kojima, M.; Miki, T. Quantitative measurement of urinary sensory function assessed by current perception threshold in the bladder using a Neurometer. Neurourology and Urodynamics, Volume 20 (Part 4):124, Ukimura, O., Miki, T., Kawauchi, A., Iwata, T., Iwata, M., Honjo, H. Preliminary results of quantitative measurement of urinary sensory function assessed by current perception threshold in the bladder. Journal of Urology, Volume 165(5 Suppl.):299, Neurometer snct /CPT Overview & References Neurotron, Inc., Balto., MD, USA

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