Join this vibrant community of professionals eager to exchange ideas, share resources, and engage in meaningful discussions. Use this platform as a sounding board to seek advice for navigating challenging cases or career decisions, and receive expert guidance from generous peers who want to help you succeed.
In order to comment on posts and view posts in their entirety, please login with your Â鶹APP member account information.
When PCP has a patient with rectal bleeding, the patient is never given a script for colonoscopy nor would a gastroenterologist do a colonoscopy without a clinical evaluation first . Shouldn't Edx studies be preceded by a neurological consult then do the EMG?
I was referred a patient who is 71 years old with a history of Gullian barre syndrome diagnosed 3 years ago in Pennsylvania treated with IVIG treatment with good recovery but with residual left side weakness. She is now ambulating with cane. At the time she had acute ascending paraplegia. Was admitted and did not need vent Current EMG is showing mixed sensory motor peripheral polyneuropathy left worse than right predominantly demyelinating. Similar picture in upper extremities. patient is clinically stable with no recent worsening of the weakness. I just reported it as a sensory motor neuropathy, without commenting on possible diagnosis. Could I call it CIDP? Or is that more clinical diagnosis. Any ideas or inputs?
Recently made aware of denial of payment due to CMS only covering 1 limb EMG/NCS charges per year. Interstingly had a request for another limb 4 mo after 1st in different calendar year, they still denied despite appeal. so you may do 2-4 limbs at a sitting but not sequentially or serially by this criteria. anyone else noticing this trend? our advocates for CMS need further education if possible gievn current environment.
Is anyone having issues with getting paid when you do two limbs with EMG? Lately i am being told to bill 95886 x RT and 95886 x LT on two separate lines based on what insurances want to see, rather than 95886 x 2.
I have years' worth of journals and I would like to donate them, but I don't know that anyone takes them. Has anyone heard of a place that will take donated journals? If not, I'll just recycle them. Thank you. Janet Balbierz
When billing NCS/EMG and NMUS Limited study 76882, (performed on the same day), Medicare ( for Northeast region) is returning the bills as incomplete claim, as MODIFIERS were not used with 76882. They do not specify which Modifiers ( 59,? XU, ? RT...????) are missing.
Does anyone have any specific experience to advise which modifiers to use for Medicare when NCS/EMG is performed on the same day, (same limb) for example.
Does anyone have a machine they no longer need and are getting rid of?
I am working thru the AAP to develop the EDX curriculum for Nepal's first PM&R training program, directed by Raju Dhakal. The department in Nepal is in need of an EMG machine for training the fellows. I would be bringing it down with me for a workshop in August.
Thanks in advance for any leads or if you would like to help with this project. Feel free to reach out to me directly at onealegf@upmc.edu.
A 76-year-old male with a remote history of a lumbar decompression at L5, presented to the Sports Medicine Clinic for a painless right foot drop that presented acutely November 2024. Of note, the patient also had a left-side foot drop with prolonged recovery after lumbar decompression in 2023. Exam on the right side demonstrated 4/5 dorsiflexion and big toe extension but 5/5 foot eversion and inversion.
A recent MRI of the lumbar spine still demonstrated bilateral right greater than left L5-S1 foraminal stenosis in the setting of grade 1 degenerative spondylolisthesis.
The NCS/EMG findings revealed the following abnormalities: decreased right superficial fibular sensory nerve amplitude, bilaterally decreased fibular CMAP amplitudes with slowed conduction velocity but no conduction block or focal slowing, and abnormal spontaneous activity with decreased recruitment only in the right tibialis anterior and extensor digitorum brevis. The other L4-S1 muscles were WNLs.
The spine surgeon is ready to do a decompression; however, these findings suggest a right fibular neuropathy at the knee level with ongoing denervation but no evidence of radiculopathy or tibial neuropathy.
I would appreciate your thoughts on this case to help guide management. I have never seen a painless fibular neuropathy predominately involving the deep branch at the knee.
I hope this message finds you well. I am reaching out to seek your insights on whether there is a standardized template or guideline for interpreting and reporting single fiber electromyography (SFEMG) findings in clinical practice. If such resources are available, I would greatly appreciate it if you could share a few example reports or templates utilized at your institutions. Your expertise and assistance in this matter would be invaluable to me. Thank you very much for your time and consideration.
Does anyone know of any issues with doing NCV studies on an extremity that has a Dexcom monitor? This came up for the first time today. The patient had it on the medial arm and I had planned to test that extremity, but held off.
Hello everyone! Thank you for taking the time to read this.
It seems that many practices want a NM neurologist to perform autonomic testing and muscle/nerve biopsies.
How would a neuromuscular practitioner/fellow obtain training in this if not offered by the fellowship in which they were/are trained? Also where can one be trained to do core needle muscle biopsies?
The Myositis International Health and Research Collaborative Alliance (MIHRA) is hosting a scientific seminar on Inclusion Body Myositis on March 26, 8-10 am CST, dedicated to both providers and patients. It is cost free.
What do you use to warm limbs. I have seen and read about heating lamps, heating pads, hydocollators, hair dryers. Are there any standards on this issue from Â鶹APP?
One of the techs here posed a question regarding the MAC and median mixed sensory nerve.
Years ago, I *think* I remember someone (maybe Dr. Dumitru?) at a maybe(?) Â鶹APP meeting mention that when testing the MAC that it is possible to record the median mixed sensory instead. Is that correct? If yes, how do you avoid recording from the median mixed sensory when stimulating the MAC?
My name is Christine Gou, and I’m currently a third-year Physiatry resident at Washington University School of Medicine. I’m applying for Neuromuscular Medicine fellowships this cycle and would love the opportunity to connect with individuals in this field to gain a deeper understanding of what a career in Neuromuscular Physiatry could look like. You can reach me at cgou@wustl.edu. Thank you in advance for your time and guidance!
Baylor Scott and White Medical Center - Baylor College of Medicine (Temple) still has 1 Clinical Neurophysiology Fellowship position opening for 7/1/2025.
Soon I will be tasked with setting up a new EMG lab at a satellite hospital. I've been thinking about choice of location of the lab in the new hospital and have been wondering about electrical interference.
Is there a way to measure/predict if this will be a problem? That is, short of setting up the EMG machine and using it in the new location?
I know folks are familiar with this problem in ICU settings, but once or twice I've run across the problem during inpatient studies, and have concluded the interference must have come from a room above or below where I was located......
I got trained in analogue era on oscilloscope and am very comfortable in qualitative EMG in motor unit analysis including interference pattern with 10-10k filter and monopolar needle for patient comfort and compliance. Time base 10 ms/div, gain 100 uv/div for spontaneous activity and 500 uv to 1 mv for MUP and IP analysis. Do I need to go into quantitative mode of turn-amplitude analysis also- am I missing too much in my understanding. My training by my Guru is unless and until I am good in quality- quantity is irrelevant - Om Peace. Dr Hans Raj
Hi all- I occasionally get requests from my movement disorders colleagues for EMG/NCS for tremor or myoclonus. I have done a cursory review of the literature and tried to help. Seems like I can help with hertz measurement, etc. They seem to use mostly surface electrode EMG. I have more recent requests that are a bit more advanced. Does anyone feel really good about neurophys techniques in movement disorders? How do you bill for surface EMG? I would be interested in a lecture on this at the Â鶹APP from any experts.
Below is an article that I was sent to see if we can do at our lab:
I have had two cases recently which I would love the group's thoughts on. Both patient's had an atraumatic onset of severe pain through the shoulder/scapular/lateral arm region. This involved some sensory symptoms and weakness. The pain was so severe to keep them awake for a few days. They both then developed significant atrophy through C5 myotomes in the coming months with scapula winging.
I saw them month approx 5 months post event. The NCS demonstrated recordable lateral cutaneous nerve responses, both within allowable symemtry of the contralateral side. The remainder of the NCS were normal (sensory/motor studies of median, ulnar, radial, antebrachial bilaterally).
The EMG demonstrated involvement of seemingly fairly isolated C5 muscles (Rhomboids, supraspin, infraspin, deltoid, biceps with sparing of brachioradialis, triceps, EDC, FDI, serratus anterior) with both spontaneous neurogenic changes and neurogenic units with reduced recruitment.
The MRI Cx spines for these patients demonstrated a mild, and a moderate (respectively) C5 formainal stenosis without nerve impingement.
The MRI plexus was normal (but this was a delayed scan post my assessment, so approx 5-6 months post event)
My questions for the group
1) Historically, involvement of Rhomboids was used to demonstrate pre-plexus localisation. There have been a number of case reports in recent times, with people documenting involvement in later diagnosed plexopathies. How many people would still use Rhomboid involvement as evidence of pre-plexus localisation?
2) Severe onset, atraumatic pain keeping patients awake with then progressive atrophy is not restricted to Brachial Plexopathies, but would make one think this, rather than a Radiculoapthy. These two patients have a very C5 isolated picture, Rhomboid involvement, seemingly spared peripheral nerves (including LABC), with mild and moderate formainal stenosis. Acknolwedging that you would be trusting my ncs skills/report, who would lean towards a radiculopathy and who towards a C5/very early upper plexoapthy.
I enjoy participating in the Â鶹APP Connect Forum for a number of reasons. There are very fundamental questions posed on a frequent basis that cause me to pause and ask myself, ‘Why didn’t I think of that?’ Also, I continue to learn
new things when others contribute their thoughts and experiences. Connect is an excellent opportunity for members to interact and to address any topic, including those that may not be discussed
at an annual meeting or journal article.
