Check your knowledge of neurodiagnostic testing
By Marc H. Sencer, MD

Are you thinking about doing NCV (nerve conduction velocity) and EMG (electromyography) tests in your office?

Test your knowledge of neurodiagnostic-testing basics with this quiz.

Which of the following statements about neurodiagnostic testing are true?
(a) As a chiropractor you may perform and interpret NCV tests in some states.

(b) It makes good business sense to use a testing company that will split the technical and professional component of the test with you, instead of adding an expensive medical specialist to do your testing.

(c) When you document the medical necessity for NCV/EMG testing, the patient's subjective complaints of tingling and numbness are most important to emphasize.

(d) It is better to have these tests performed by a neurologist than a physiatrist, because neurologists have more specialty training in this area.

(e) The NCV test is best for diagnosing lesions of the peripheral nerves, while the EMG is more useful for the diagnosis of spinal nerve root lesions.

The correct answers are (a) and (e).

(a) True. In some states chiropractors may become board-certified in electrodiagnostic testing by taking a rigorous program of special training. Typically these courses are given on weekends and may take a year or longer to complete.

After becoming certified, a chiropractic physician may perform and interpret NCV tests in states that recognize this type of certification.

Keep in mind, however, that some payers do not reimburse for these tests. And if you become certified, you will be creating yet another job for yourself, and will be moving one step away from having a practice that can run effectively without you.

(b) False. Reimbursement is generally very poor when you split the technical and professional components of these tests. In addition, doing so raises a flag with most payers, and will subject your claim to extra scrutiny and review.

Some testing companies propose to pay you a rental fee for the use of your space, and they collect the reimburse-ment for the test. For this arrangement to be legal, the rent must be so small it would not be worth the trouble. Even though hiring a medical specialist introduces more overhead, it is more profitable to do your testing this way.

(c) False. For purposes of documenting medical necessity, the patient's subjective complaints are much less important than objective findings. This applies to most medical and chiropractic procedures, and neurodiagnostic tests are no exception.

Objective criteria, such as positive findings on the neurological exam, MRI showing nerve-root compression, or past history of positive electrodiagnostic findings, are the kinds of things insurance companies look for when they ask you for medical necessity.

Remember, also, that if you established medical necessity when you ordered the test, a negative result from the test is not in itself a justification for an automatic denial by the insurance company. You should challenge these denials if they occur.

(d) False. Neurologists and physiatrists both have subspecialty fellowships in electrodiagnostic testing, and it is within the scope of each of these specialties to do these tests.

(e) True.Typically these tests are done together, because usually the diagnostic challenge is to determine whether symptoms are caused by a problem in the peripheral nerves (such as carpal tunnel syndrome), a problem in the nerve roots (such as radiculitis), or a combination of the two, often referred to as "double crush."

The information these tests provide is invaluable in making diagnostic decisions and often leads to important changes in the treatment plan. For example: If damage to the median nerve is occurring, you could refer the patient for surgical treatment that would preserve the function of the nerve, whereas a less serious case of carpal tunnel syndrome can be managed with wrist splints and therapy.

Marc H. Sencer, MD, is the president and founder of MDs for DCs, which provides intensive one-on-one training, medical staffing, and ongoing practice-management support to integrated chiropractic practices. He can be reached at 800-916-1462 or www.mdsfordcs.com.