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Neurophysiologic Testing and Monitoring
UnitedHealthcare® Commercial Medical Policy Neurophysiologic Testing and Monitoring Policy Number: 2021T0493Z Effective Date: January 1, 2021 Instructions for Use Table of Contents Page Community Plan Policy Coverage Rationale ........................................................................... 1 • Neurophysiologic Testing and Monitoring Applicable Codes .............................................................................. 2 Description of Services ..................................................................... 4 Medicare Advantage Coverage Summary Clinical Evidence ............................................................................... 6 • Neurophysiological Studies U.S. Food and Drug Administration ..............................................16 References .......................................................................................18 Policy History/Revision Information..............................................21 Instructions for Use .........................................................................22 Coverage Rationale Nerve Conduction Studies The following are proven and medically necessary: • Nerve conduction studies with or without late responses (e.g., F-wave and H-reflex tests) and neuromuscular junction testing when performed in conjunction with needle electromyography for any of the following known or suspected disorders: o Peripheral neuropathy/polyneuropathy (e.g., inherited, metabolic, traumatic, entrapment syndromes) o Plexopathy o Neuromuscular junction disorders (e.g., -
ANMC Specialty Clinic Services
Cardiology Dermatology Diabetes Endocrinology Ear, Nose and Throat (ENT) Gastroenterology General Medicine General Surgery HIV/Early Intervention Services Infectious Disease Liver Clinic Neurology Neurosurgery/Comprehensive Pain Management Oncology Ophthalmology Orthopedics Orthopedics – Back and Spine Podiatry Pulmonology Rheumatology Urology Cardiology • Cardiology • Adult transthoracic echocardiography • Ambulatory electrocardiology monitor interpretation • Cardioversion, electrical, elective • Central line placement and venous angiography • ECG interpretation, including signal average ECG • Infusion and management of Gp IIb/IIIa agents and thrombolytic agents and antithrombotic agents • Insertion and management of central venous catheters, pulmonary artery catheters, and arterial lines • Insertion and management of automatic implantable cardiac defibrillators • Insertion of permanent pacemaker, including single/dual chamber and biventricular • Interpretation of results of noninvasive testing relevant to arrhythmia diagnoses and treatment • Hemodynamic monitoring with balloon flotation devices • Non-invasive hemodynamic monitoring • Perform history and physical exam • Pericardiocentesis • Placement of temporary transvenous pacemaker • Pacemaker programming/reprogramming and interrogation • Stress echocardiography (exercise and pharmacologic stress) • Tilt table testing • Transcutaneous external pacemaker placement • Transthoracic 2D echocardiography, Doppler, and color flow Dermatology • Chemical face peels • Cryosurgery • Diagnosis -
What Is the Autonomic Nervous System?
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.74.suppl_3.iii31 on 21 August 2003. Downloaded from AUTONOMIC DISEASES: CLINICAL FEATURES AND LABORATORY EVALUATION *iii31 Christopher J Mathias J Neurol Neurosurg Psychiatry 2003;74(Suppl III):iii31–iii41 he autonomic nervous system has a craniosacral parasympathetic and a thoracolumbar sym- pathetic pathway (fig 1) and supplies every organ in the body. It influences localised organ Tfunction and also integrated processes that control vital functions such as arterial blood pres- sure and body temperature. There are specific neurotransmitters in each system that influence ganglionic and post-ganglionic function (fig 2). The symptoms and signs of autonomic disease cover a wide spectrum (table 1) that vary depending upon the aetiology (tables 2 and 3). In some they are localised (table 4). Autonomic dis- ease can result in underactivity or overactivity. Sympathetic adrenergic failure causes orthostatic (postural) hypotension and in the male ejaculatory failure, while sympathetic cholinergic failure results in anhidrosis; parasympathetic failure causes dilated pupils, a fixed heart rate, a sluggish urinary bladder, an atonic large bowel and, in the male, erectile failure. With autonomic hyperac- tivity, the reverse occurs. In some disorders, particularly in neurally mediated syncope, there may be a combination of effects, with bradycardia caused by parasympathetic activity and hypotension resulting from withdrawal of sympathetic activity. The history is of particular importance in the consideration and recognition of autonomic disease, and in separating dysfunction that may result from non-autonomic disorders. CLINICAL FEATURES c copyright. General aspects Autonomic disease may present at any age group; at birth in familial dysautonomia (Riley-Day syndrome), in teenage years in vasovagal syncope, and between the ages of 30–50 years in familial amyloid polyneuropathy (FAP). -
New Insights in Lumbosacral Plexopathy
New Insights in Lumbosacral Plexopathy Kerry H. Levin, MD Gérard Said, MD, FRCP P. James B. Dyck, MD Suraj A. Muley, MD Kurt A. Jaeckle, MD 2006 COURSE C AANEM 53rd Annual Meeting Washington, DC Copyright © October 2006 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 PRINTED BY JOHNSON PRINTING COMPANY, INC. C-ii New Insights in Lumbosacral Plexopathy Faculty Kerry H. Levin, MD P. James. B. Dyck, MD Vice-Chairman Associate Professor Department of Neurology Department of Neurology Head Mayo Clinic Section of Neuromuscular Disease/Electromyography Rochester, Minnesota Cleveland Clinic Dr. Dyck received his medical degree from the University of Minnesota Cleveland, Ohio School of Medicine, performed an internship at Virginia Mason Hospital Dr. Levin received his bachelor of arts degree and his medical degree from in Seattle, Washington, and a residency at Barnes Hospital and Washington Johns Hopkins University in Baltimore, Maryland. He then performed University in Saint Louis, Missouri. He then performed fellowships at a residency in internal medicine at the University of Chicago Hospitals, the Mayo Clinic in peripheral nerve and electromyography. He is cur- where he later became the chief resident in neurology. He is currently Vice- rently Associate Professor of Neurology at the Mayo Clinic. Dr. Dyck is chairman of the Department of Neurology and Head of the Section of a member of several professional societies, including the AANEM, the Neuromuscular Disease/Electromyography at Cleveland Clinic. Dr. Levin American Academy of Neurology, the Peripheral Nerve Society, and the is also a professor of medicine at the Cleveland Clinic College of Medicine American Neurological Association. -
A Clinical Study on the Utility of Nerve Biopsy in Peripheral Neuropathy
A CLINICAL STUDY ON THE UTILITY OF NERVE BIOPSY IN PERIPHERAL NEUROPATHY Thesis submitted for the partial fulfilment for the requirement of the degree of DM Neurology DR. JITESH GOEL DM NEUROLOGY RESIDENT 2014–2016 DEPARTMENT OF NEUROLOGY SREE CHITRA TIRUNAL INSTITUTE FOR MEDICAL SCIENCES AND TECHNOLOGY, TRIVANDRUM, KERALA 695011 i DECLARATION I, Dr Jitesh hereby declare that the thesis “A CLINICAL STUDY ON THE UTILITY OF NERVE BIOPSY IN PERIPHERAL NEUROPATHY” was undertaken by me under the guidance and supervision of Dr MD Nair, Senior Professor and Head of Department, Department of Neurology at the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. Dr.Jitesh Goel Thiruvananthapuram Senior Resident Date: Dept. of Neurology SCTIMST Thiruvananthapuram ii CERTIFICATE This is to certify that the thesis titled “A CLINICAL STUDY ON THE UTILITY OF NERVE BIOPSY IN PERIPHERAL NEUROPATHY”, is the bonafide work of Dr Jitesh Goel, Senior Resident, DM Neurology and has been done under my direct guidance and supervision at the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. He has shown keen interest in the research project and actively participated in all its phases. Thiruvananthapuram Dr MD Nair (Guide) Date: Senior Professor and Head of Department Department of Neurology, SCTIMST. Thiruvananthapuram iii CONTENTS Sl. No. Title Page No. 1 Introduction 1 2 Review of Literature 3 3 Aim of The Study 32 4 Materials And Methods 32 5 Results 34 6 Discussion 62 7 Conclusion 72 8 References 75 9 Annexures 84 IEC Approval Proforma iv INTRODUCTION Peripheral neuropathy is among the common disorders in patients attending neuromuscular clinic. -
Peripheral Nerve Endoscopy: a Cadaveric Study
THE UNIVERSITY OF NEW SOUTH WALES Thesis/Dissertation Sheet Surname or Family name: MOBBS First name: RALPH Other name/s: JASPER Abbreviation for degree: MASTER OF SURGERY School: ANATOMY Faculty: SURGERY Title: Peripheral Nerve Endoscopy: a cadaveric study. Peripheral nerve problems are common and encompass a wide ~pectrum of diseases, traumatic injuries and mass lesions. There have been few major technical advances in peripheral nerve surgery over the last three decades with exception of endoscopic carpal tunnel release, intraoperative nerve action potential recording and nerve grafting. Certain nerves in the upper and lower extremities are vulnerable to entrapment at specific anatomic locations by virtue of th ere being superficial, fixed in position, or coursing across a joint. Peripheral nerve surgeons often encounter patients who suffer fr :>m these entrapment syndromes, the most common being carpal tunnel syndrome, for which endoscopic techniques have been d;scussed in the Iiterature since the early 1980' s. Otherwise there have been few reports in the literature that discuss the utility of endoscopic surgery for the treatment of peripheral nerve problems. Endoscopy has however been alluded to as a possible future less invasive technique for the exploration and treatment of nerve pathologies. The aim of this cadaveric study is to illustrate that using standard equipment available in most hospitals, and using principles of subcutaneous fascial dissection and expansion, that a select range of peripheral nerve problems can be dealt with using endoscopy. A study using both embalmed cadaveric specimens and fresh cadavers v.as used to evaluate potential endoscopic techniques. A set of rules was developed to decide if a nerve exposure was possible. -
Use of Magnetic Resonance Neurography for Evaluating The
Original Article | Neuroimaging and Head & Neck eISSN 2005-8330 https://doi.org/10.3348/kjr.2019.0739 Korean J Radiol 2020;21(4):483-493 Use of Magnetic Resonance Neurography for Evaluating the Distribution and Patterns of Chronic Inflammatory Demyelinating Polyneuropathy Xiaoyun Su, PhD1, 2, Xiangquan Kong, PhD1, 2, Zuneng Lu, PhD3, Min Zhou, PhD1, 2, Jing Wang, PhD1, 2, Xiaoming Liu, MD1, 2, Xiangchuang Kong, MD1, 2, Huiting Zhang, PhD4, Chuansheng Zheng, PhD1, 2 1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; 2Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China; 3Department of Neurology, Renming Hospital of Wuhan University, Wuhan, China; 4MR Scientific Marketing, Siemens Healthineers, Shanghai, China Objective: To evaluate the distribution and characteristics of peripheral nerve abnormalities in chronic inflammatory demyelinating polyneuropathy (CIDP) using magnetic resonance neurography (MRN) and to examine the diagnostic efficiency. Materials and Methods: Thirty-one CIDP patients and 21 controls underwent MR scans. Three-dimensional sampling perfections with application-optimized contrasts using different flip-angle evolutions and T1-/T2- weighted turbo spin- echo sequences were performed for neurography of the brachial and lumbosacral (LS) plexus and cauda equina, respectively. Clinical data and scores of the inflammatory Rasch-built overall disability scale (I-RODS) in CIDP were obtained. Results: The bilateral extracranial vagus (n = 11), trigeminal (n = 12), and intercostal nerves (n = 10) were hypertrophic. Plexus hypertrophies were observed in the brachial plexus of 19 patients (61.3%) and in the LS plexus of 25 patients (80.6%). Patterns of hypertrophy included uniform hypertrophy (17 [54.8%] brachial plexuses and 21 [67.7%] LS plexuses), and multifocal fusiform hypertrophy (2 [6.5%] brachial plexuses and 4 [12.9%] LS plexuses) was present. -
Hyperparathyroidism
HYPERPARATHYROIDISM Edited by Gonzalo Díaz-Soto and Manuel Puig-Domingo Hyperparathyroidism Edited by Gonzalo Díaz-Soto and Manuel Puig-Domingo Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Romana Vukelic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from [email protected] Hyperparathyroidism, Edited by Gonzalo Díaz-Soto and Manuel Puig-Domingo p. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular -
1 Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL
Annex 2. AHRQ ICD-9 Procedure Codes 0044 PROC-VESSEL BIFURCATION OCT06- 0201 LINEAR CRANIECTOMY 0050 IMPL CRT PACEMAKER SYS 0202 ELEVATE SKULL FX FRAGMNT 0051 IMPL CRT DEFIBRILLAT SYS 0203 SKULL FLAP FORMATION 0052 IMP/REP LEAD LF VEN SYS 0204 BONE GRAFT TO SKULL 0053 IMP/REP CRT PACEMAKR GEN 0205 SKULL PLATE INSERTION 0054 IMP/REP CRT DEFIB GENAT 0206 CRANIAL OSTEOPLASTY NEC 0056 INS/REP IMPL SENSOR LEAD OCT06- 0207 SKULL PLATE REMOVAL 0057 IMP/REP SUBCUE CARD DEV OCT06- 0211 SIMPLE SUTURE OF DURA 0061 PERC ANGIO PRECEREB VES (OCT 04) 0212 BRAIN MENINGE REPAIR NEC 0062 PERC ANGIO INTRACRAN VES (OCT 04) 0213 MENINGE VESSEL LIGATION 0066 PTCA OR CORONARY ATHER OCT05- 0214 CHOROID PLEXECTOMY 0070 REV HIP REPL-ACETAB/FEM OCT05- 022 VENTRICULOSTOMY 0071 REV HIP REPL-ACETAB COMP OCT05- 0231 VENTRICL SHUNT-HEAD/NECK 0072 REV HIP REPL-FEM COMP OCT05- 0232 VENTRI SHUNT-CIRCULA SYS 0073 REV HIP REPL-LINER/HEAD OCT05- 0233 VENTRICL SHUNT-THORAX 0074 HIP REPL SURF-METAL/POLY OCT05- 0234 VENTRICL SHUNT-ABDOMEN 0075 HIP REP SURF-METAL/METAL OCT05- 0235 VENTRI SHUNT-UNINARY SYS 0076 HIP REP SURF-CERMC/CERMC OCT05- 0239 OTHER VENTRICULAR SHUNT 0077 HIP REPL SURF-CERMC/POLY OCT06- 0242 REPLACE VENTRICLE SHUNT 0080 REV KNEE REPLACEMT-TOTAL OCT05- 0243 REMOVE VENTRICLE SHUNT 0081 REV KNEE REPL-TIBIA COMP OCT05- 0291 LYSIS CORTICAL ADHESION 0082 REV KNEE REPL-FEMUR COMP OCT05- 0292 BRAIN REPAIR 0083 REV KNEE REPLACE-PATELLA OCT05- 0293 IMPLANT BRAIN STIMULATOR 0084 REV KNEE REPL-TIBIA LIN OCT05- 0294 INSERT/REPLAC SKULL TONG 0085 RESRF HIPTOTAL-ACET/FEM -
Neurolymphomatosis Presenting As Brachial Plexopathy with Involvement of Cranial Nerves
CASE REPORT Ann Clin Neurophysiol 2018;20(1):44-48 https://doi.org/10.14253/acn.2018.20.1.44 ANNALS OF CLINICAL NEUROPHYSIOLOGY Neurolymphomatosis presenting as brachial plexopathy with involvement of cranial nerves Hye Jung Lee1, Keun Soo Kim1, Pamela Song1, Jae-Jung Lee1, Jung-Joon Sung2, Kyomin Choi3, Bohyun Kim4, and Joong-Yang Cho1 1Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea 2Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea 3Department of Neurology, Konkuk University Medical Center, Seoul, Korea 4Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Received: June 23, 2017 Seoul, Korea Revised: September 5, 2017 Accepted: September 25, 2017 Neurolymphomatosis (NL) is a rare disease characterized by lymphomatous invasion of the cranial or peripheral nerves by lymphoma. A high suspicion is important due to the various presenting symptoms mandating consideration of many differential diagnoses. We report a case of NL of the cranial nerves and plexus presenting as diplopia, facial palsy, and weakness of the upper and lower limbs in sequence. Key words: Neurolymphomatosis; Cranial nerves; Plexus Correspondence to Joong-Yang Cho Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Neurolymphomatosis (NL) is defined as the infiltration of the peripheral nervous system Goyang 10380, Korea including cranial -
Form 8-K AXOGEN, INC
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 8-K Current Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of Report (Date of earliest event reported): February 22, 2021 AXOGEN, INC. (Exact Name of Registrant as Specified in Charter) Minnesota 001-36046 41-1301878 (State or Other Jurisdiction of (Commission File Number) (I.R.S. Employer Identification No.) Incorporation or Organization) 13631 Progress Boulevard, Suite 400 Alachua, Florida 32615 (Address of principal executive offices) (Zip Code) (386) 462-6800 (Registrant's telephone number, including area code) N/A (Former Name or Former Address, if Changed Since Last Report) Check the appropriate box if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions (see General Instruction A.2. below): Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e- 4(c)) Securities registered pursuant to Section 12(b) of the Act: Title of each class Trading Symbol(s) Name of exchange on which registered Common Stock, $0.01 par value AXGN The Nasdaq Stock Market Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2 of this chapter).