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NeuroMetrix Inc. Message Board

  • cholepia cholepia Jan 26, 2009 7:54 PM Flag

    New CPT I does NOT apply to NC-Stat

    Call me whatever you want, but if anyone can argue with the following I will fully admit error:

    I was curious what those "modifications" were in the blurb posted below so I .... actually read the minutes, which is probably more than so called analyst: I can't download the whole thing from this computer, but link:

    https://collaborate.ama-assn.org/gm/folder-1.11.23225?agendaid=1.11.21707

    If someone wants to print out the whole section on preconfigured electrodes, please do. But one specific modification WIPES out NC-Stat: Reports must be prepared ON SITE, BY THE EXAMINER". This is not NC-STAT, and it is one beef with the product.

    With NC-STAT, an "On Call Report" is the modus operandi: "The onCall Information System provides hardcopy or electronic documentation of study results. Reports are returned to your office via fax or email in a matter of minutes. "

    There will be no way to retrofit current NC-STAT machines to do the report by the examiner on site. I suspect neurometrix is trying to figure out how to spin this, which is why we have heard little from them.

    If you are not familiar with any knowledge of this particular field, this will seem like a small triviality. Otherwise you will realize this is a biggie.

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    • I talked with an office using NC-Stat today and they told me that the results are immediate. Not sure how they are immediate but she said they print off the results right when they are done with the test.

    • NC-Stat does it all
      The physician can do the test and the interpretation "or" it can be sent in.

      This is from one of the doctors write-ups on the Neurometrix site:

      Additionally, in many intances a technician will perform the test, with cursory physician review of the printed wave forms followed by interpretation. Essentially automation represents a spectrum, with manual performance of all aspects of the test at one end, ranging to an automated test requiring limited human insight at the other end.

    • Here is what was exactly written in the notes:

      III. OLD BUSINESS
      Tab 5: Nerve Testing
      The Panel accepted on-site Option B with noted modifications to establish a Category I code to report the performance of motor and sensory nerve conduction using pre-configured arrays. The Panel also accepted addition of new guidelines to assist in differentiating nerve conduction studies performed with individually placed stimulating electrodes from tests performed with preconfigured electrode arrays. The new option included the description of the typical patient. The Panel directed that the description of service would be provided in the RUC summary.
      Category I
      Medicine
      Neurology and Neuromuscular Procedures
      Nerve Conduction Tests

      The following apply to nerve conduction tests (95900-95904): Codes 95900-95904 describe nerve conduction tests when performed with individually placed stimulating, recording and ground electrodes. The stimulating, recording and ground electrode placement and the test design must be individualized to the patient's unique anatomy. Nerves tested must be limited to the specific nerves and conduction studies needed for the particular clinical question being investigated. The stimulating electrode must be placed directly over the nerve to be tested, and stimulation parameters properly adjusted to avoid stimulating other nerves or nerve branches. In most motor nerve conduction studies, and in some sensory and mixed nerve conduction studies, both proximal and distal stimulation will be used. Motor nerve conduction study recordings must be made from electrodes placed directly over the motor point of the specific muscle to be tested. Sensory nerve conduction study recordings must be made from electrodes placed directly over the specific nerve to be tested. Waveforms must be reviewed on site in real time, and the technique (stimulus site, recording site, ground site, filter settings) must be adjusted, as appropriate, as the test proceeds in order to minimize artifact, and to minimize the chances of unintended stimulation of adjacent nerves and the unintended recording from adjacent muscles or nerves. Reports must be prepared on site by the examiner, and consist of the work product of the interpretation of numerous test results, using well-established techniques to assess the amplitude, latency and configuration of waveforms elicited by stimulation at each site of each nerve tested. This includes the calculation of nerve conduction velocities, sometimes including specialized F-wave indices, along with comparison to normal values, summarization of clinical and electrodiagnostic data, and physician or other qualified healthcare professional interpretation.

      Code 9590X1 describes nerve conduction tests when performed with preconfigured electrodes customized to a specific anatomic site.
      95900 Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study
      9590X1 Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study; each limb, includes with or without F-wave study F wave study when performed, with interpretation and report
      (Report 9590X1 only once per limb studied)
      (Do not report 9590X1 in conjunction with 95900-95904, 95934-95936)
      Typical Patient (9590X1):
      A 42-year-old female data entry clerk reported that, although she had had no injuries and during the day she was okay, she had been awakened in the middle of each night for the past two weeks with a numb, aching, burning feeling in her right hand that was relieved by holding her hand down and shaking it, rubbing it and running cold water over it. Physical examination reveals weakness of right thumb abduction, wasting of the right thenar eminence, numbness of the palmar aspects of the right thumb, index finger and middle finger, and a Tinel’s sign over the right median nerve at the carpal tunnel. (History and exam reported separately as E/M.)

    • Cholepia, you raise a good point. However, in the context ofclinical practice, "on site" can mean many things. Did you know that radiologic consults are frequently done in India and filed back to the referring physician? Many diagnostic interpretations are not done on-site. I think we're talking about the nuance of parsed words. The AMA doesn't want a virtual test performed and interpreted by non-physicians. The AMA wants physicians to charge for on-site visits, which means that the patient has to be seen and the sensors applied in the physicians' office. In any event, the minutes of the meeting, at the very least will enable Gozani to challenge insurance companies unwilling to reimburse for the test. It may also insulate them, in part, for overeaching sales practices in the past through the Mass. A.G. Office.

    • The on call just beefs up the reports. This is not a hard thing to tweak. The NC-Stat just does an extra service.
      The big victory is that this kind of test will be reimbursed. Good point though!

      • 2 Replies to highoctanejuice
      • NC-Stat can not produce reports at the time of the study because the studies are read remotely by neurologist or PMR doctors. There is no way to do the report right then. It is always sent a few days or a week later. You obviously don't know much about how the NC-Stat works or how neurodiagnostics in general are done.

      • Nope, it doesn't "beef up the reports" - it generates them and that's a no no under this CPT:

        http://www.neurotechreports.com/pages/neurometrixprofile.html

        "The company’s current product line includes a nerve-conduction monitoring system called NC-stat, biosensors used with the median and ulnar nerves, and a management information system that connects a clinician’s office with a report-generation system engine located at NeuroMetrix offices."
        "In the long run, perhaps the most lucrative product in the NeuroMetrix line is its onCall Information Management System. Neurotech Reports projects the market for neurodiagnostic reports to grow from $26 million this year to $110 million in 2005. Physicians access onCall via the Internet or fax. The onCall website provides physicians “patient specific” information that corresponds directly to the information contained in the onCall report."


        Can NURO (or any company) come up with a product that satisfies these requirements. Sure, but it aint NC-STAT.

        "

 
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