Exam m notes f05

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Exam m notes f05

Aetna considers evoked potential studies medically necessary for the following indications: SEPs and DSEPs are considered experimental and investigational for all other indications because their effectiveness for indications other than the ones listed above has not been established.

Intraoperative somatosensory evoked potentials SSEPs performed either alone, or in combination with motor evoked potentials MEPs are considered medically necessary for monitoring the integrity of the spinal cord to detect adverse changes before they become irreversible during spinal, intracranial, orthopedic, or vascular procedures, when the following criteria are met: Intra-operative SEP monitoring, with or without MEPs, may be appropriate for the following types of surgery not an all-inclusive list: Correction of scoliosis or deformity of the spinal cord involving traction on the cord Decompression of the spinal cord where function of the spinal cord is at risk Removal of spinal cord tumors Surgery as a result of traumatic injury to the spinal cord Surgery for arteriovenous AV malformation of the spinal cord Intracranial Surgeries: Correction of cerebral vascular aneurysms e.

Arteriography, during which there is a test occlusion of the carotid artery Circulatory arrest with hypothermia does not include surgeries performed under circulatory bypass such as CABG, and ventricular aneurysms Distal aortic procedures, where there is risk of ischemia to the spinal cord Surgery of the aortic arch, its branch vessels, or thoracic aorta, including carotid artery surgery e.

Background

Depending on the clinical condition being investigated, it may be medically necessary to test several nerves in one extremity and compare them with the opposite limb. It offers 2 types of monitoring modalities: Note on documentation requirements: The physician's SEP report should note which nerves were tested, latencies at various testing points, and an evaluation of whether the resulting values are normal or abnormal.

See appendix for additional details on documentation requriements. Visual evoked potentials VEPs are considered medically necessary for any of the following indications: To diagnose and monitor multiple sclerosis acute or chronic phases ; or To evaluate signs and symptoms of visual loss in persons who are unable to communicate e.

Standard or automated VEPs are considered experimental and investigational for routine screening of infants and other persons; evidence-based guidelines from leading medical professional organizations and public health agencies have not recommended VEP screening of infants.

VEPs are considered experimental and investigational for all other indications because their effectiveness for indications other than the ones listed above has not been established.

Evoked Potential Studies - Medical Clinical Policy Bulletins | Aetna

For purposes of neonatal screening, only limited auditory evoked potentials or limited evoked otoacoustic emissions are considered medically necessary. Neonates who fail this screening test are then referred for comprehensive auditory evoked response testing or comprehensive otoacoustic emissions.

Comprehensive auditory evoked response testing and comprehensive otoacoustic emissions are considered experimental and investigational for neonatal screening because there is a lack of evidence of the value of comprehensive testing over the limited auditory evoked potentials or limited otoacoustic emissions for this indication.

BAERs are considered experimental and investigational for all other indications because their effectiveness for indications other than the ones listed above has not been established. Aetna considers the following studies and indications to be experimental and investigational because they have not been proven necessary to aid in diagnosis or alter the management of the member: Diagnosis ; Intraoperative BAER during stapedectomy, tympanoplasty and ossicle reconstruction; Intraoperative MEP during implantation of a spinal cord stimulator; Intraoperative neuromonitoring during adjustment of vertical expandable prosthetic titanium rib; Intraoperative saphenous nerve somatosensory evoked potential for monitoring the femoral nerve during transpoas lumbar lateral interbody fusion; Intraoperative SSEP of the facial nerve for submandibular gland excision or parotid gland surgery, during hip replacement surgery, implantation of a spinal cord stimulator, off-pump coronary artery bypass surgery, and for thyroid surgery and parathyroid surgery because they have not been proven necessary to aid in diagnosis or alter the management of individual undergoing surgical treatment ; Intraoperative SSEP, with or without MEPs, for cochlear implantation, decompression of the trigeminal nerve, implantation of vagus nerve stimulator, monitoring spinal injections e.

Background Evoked potentials measure conduction velocities of sensory pathways in the central nervous system using computerized averaging techniques. Three types of evoked potentials are routinely performed: In each of these tests a peripheral sense organ is electrically stimulated and conduction velocities are recorded for central somatosensory pathways located in the posterior columns of the spinal cord, brain stem, and thalamus, and the primary sensory cortex located in the parietal lobes.

Mental Health History Words

Somatosensory evoked potentials SEPs or SSEPs also known as cerebral sensory evoked potentials augment the sensory examination and are most useful in assessing the spinal nerve roots, spinal cord, or brain stem for evidence of delayed nerve conduction. Dermatomal somatosensory evoked potentials DSEPs are elicited by stimulating the skin "signature" areas of specific nerve roots.

Both techniques involve production and recording of small electrophysiological responses of the central nervous system that follow sequential electrical stimulation of peripheral nerves. These small electrophysiological responses are extracted from the background noise of electroencephalography EEGusually by signal averaging techniques.

Delays in signal propagation suggest lesions of the central sensory pathways. Although controversial, evoked potentials have been used to assess the prognosis of children with spinal cord lesions, brain malformations, and neurodegenerative diseases, as well as young children who are at risk for brain injury, such as preterm infants.

Somatosensory evoked potentials measurements have been used to predict outcome in spinal cord injury; however, signal changes on MRI actually may be more useful in determining the severity of injury. Hemorrhage within the spinal cord is readily identified on MRI, and such hemorrhage is predictive of injury severity.

Intra-operative SSEP measurements are useful in complex neurologic, orthopedic, and vascular surgical procedures as a means of gauging nerve injury during surgery e. Somatosensory evoked potentials are altered by conditions that affect the somatosensory pathways, including both focal lesions such as strokes, tumors, cervical spondylosis, syringomyelia and diffuse diseases such as hereditary systemic neurologic degeneration, subacute combined degeneration, and vitamin E deficiencies.All medical necessity criteria must be clearly documented in the member's medical record and made available upon request.

The member's medical record must contain documentation that fully supports the medical necessity for evoked potential studies. Readbag users suggest that PDF is worth reading. The file contains page(s) and is free to view, download or print.

Exam m notes f05

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All medical necessity criteria must be clearly documented in the member's medical record and made available upon request. The member's medical record must contain documentation that fully supports the medical necessity for evoked potential studies.

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Mental Health (History) Dictionary