Automated Point-of-Care Nerve Conduction Tests

Nerve conduction studies (NCS) and needle electromyography (EMG), when properly performed by a trained practitioner, are considered the gold standard of electrodiagnostic testing. However, the need for specialized equipment and personnel may limit the availability of electrodiagnostic testing for some patients.

Portable devices have been developed to provide point-of-care NCS. These portable devices have computational algorithms that are able to drive stimulus delivery, measure and analyze the response, and provide a detailed report of study results. Automated nerve conduction devices can be used in various settings, including primary care, without the need for specialized training or equipment.

Nerve conduction is typically assessed prior to surgical release of the carpal tunnel, but the use of electromyography in the diagnosis of carpal tunnel syndrome (CTS) is controversial.

Point-of-care nerve conduction testing has also been proposed for the diagnosis of peripheral neuropathy and, in particular, for detecting neuropathy in patients with diabetes. Peripheral neuropathy is relatively common in patients with diabetes mellitus, and the diagnosis is often made clinically through the physical examination.

NC-stat® by NeuroMetrix is a portable nerve conduction test device designed to be used at the point-of-care. The system is comprised of a biosensor array, an electronic monitor, and a remote report generation system. The biosensor is a single use, preconfigured array consisting of a stimulation anode and cathode, skin surface digital thermometer, and response sensor. Biosensor arrays are available for assessment of sensory and motor nerves of the wrist (median and ulnar), and for the foot (peroneal, posterior tibial, and sural). Data are sent to a remote computer via a modem in the docking station, and the remote computer generates a report based on the average of six responses that is sent back by fax or email.

After a review of the relevant literature, HMSA has determined that automated point-of-care nerve conduction tests do not meet HMSA's Payment Determination Criteria. Studies have failed to provide clinical evidence that these tests improve health outcomes. As a result, HMSA will not cover these tests.

HMSA does not consider NC-stat billed with CPT codes 95900, 95903, and 95904 to be appropriately coded as a nerve conduction study. These services should be billed with S3905 (non-invasive electrodiagnostic testing with automated hand-held device to stimulate and measure neuromuscular signals in diagnosing and evaluating systemic and entrapment neuropathies). Improper coding of this service will result in audits and/or requests for return of payment.

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