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Abstract

Intraoperative neurophysiological monitoring (IONM) is used as an adjunct for surgeries that pose risk to nervous system structures. IONM is performed by a technologist in the operating room and is overseen by a highly trained fellowship-trained physician clinical neurophysiologist. Telemedicine has allowed the professional oversight component to be done remotely, with reimbursement for multiple simultaneous cases. Recent changes to Current Procedure Terminology coding and Medicare reimbursement policies provide options only for exclusive 1:1 technologist:oversight physician billing. This policy change may create profound repercussions in the practice of telemedicine by actively discouraging the leveraging of highly specialized and scarce expertise through on-site physician extenders.

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References

Fehlings

, Brodke

, Norvell

, Dettori

. The evidence for intraoperative neurophysiological monitoring in spine surgery: Does it make a difference? Spine (Phila Pa 1976), 2010; 35,9 Suppl:S37–S46.

The role of electrodiagnostic technologists in the operating room. Muscle Nerve, 2000; 23:1443–1444.

CNIM exam eligibility requirements. http://abret.org/. 2012 December 31.

Nuwer

, Emerson

, Galloway

et al. Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials. Neurology, 2012; 78:585–589.

Physician fee schedule, by HCPCS code. www.cms.gov. 2012 December 18.

Ney

, van der Goes

, Watanabe

. Cost-effectiveness of intraoperative neurophysiological monitoring for spinal surgeries: Beginning steps. Clin Neurophysiol, 2012; 123:1705–1707.

Nuwer

, Dawson

, Carlson

, Kanim

, Sherman

. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits. Electroencephalogr Clin Neurophysiol, 1995; 96:6–11.

Ney

, van der Goes

. Intraoperative neurophysiological monitoring in spinal surgeries: Impact on neurological complications, mortality, and cost. Presented at the American Academy of Neurology Annual Meeting, April 26, 2012 New Orleans.

Elixhauser

, Andrews

. Profile of inpatient operating room procedures in US hospitals in 2007. Arch Surg, 2010; 145:1201–1208.

10.

Principles of coding for intraoperative neurophysiologic monitoring (IOM) and testing, American Academy of Neurology, model medical policy. www.aan.com. 2012 December 31.

11.

Barkley

. CPT^® and RBRVS 2013 Annual Symposium–Neurology. Presented at the CPT® and RBRVS 2013 Annual Symposium, November 16, 2012 Chicago.

12.

Centers for Medicare & Medicaid Services. Medicare program; revisions to payment policies under the physician fee schedule, DME face-to-face encounters, elimination of the requirement for termination of non-random prepayment complex medical review and other revisions to Part B for CY 2013. 77 Fed Register, 2012; 68891–69373.

13.

IOM company report: Intra-op services of Covington LA closing down operations—Chapter 11?. http://unpa.pro/. 2012 December 31.

Changes to CMS Reimbursement Rules for Intraoperative Neurophysiological Monitoring: Implications for Telemedicine

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