• Monitor evoked potentials
• Triggered electromyography
• Cranial nerve monitoring
• Lumbar plexus monitoring for XLIF and DLIF
"Clinical neural diagnostics and IONM are very similar," said Dr. Davis. "You take the clinical neural diagnostics and put it in a dynamic setting and you have IONM."
Dr. Davis discussed several factors for physicians and ASC administrators to keep in mind when choosing IONM services.
1. Physician must be doing the reading. A physician other than the physician who is performing surgery must do the IONM reading in real time, said Dr. Davis, in order for the service to be billable. "Sometimes intraoperative monitoring technicians do the reading and surgeons are looking at them as the authority and they don't have any oversight," said Dr. Davis. "Find out who is doing the readings and make sure they have medical training."
2. Make sure the circuit of electricity is complete. Since patients are different, it takes someone with considerable education and experience to complete the electricity circuit for neurodiagnositc testing. "Make sure the electrodes are in the right place and circuit is intact," said Dr. Davis. "It requires a certain level of training and critical thinking to do. It's different between an obese and slender person when finding the nerve."
3. Be skeptical of sales gimmicks. Make sure you are getting a good deal on the equipment, including the electrodes. Companies may offer a huge discount on equipment, but then over charge on electrodes. "Third party vendors will provide equipment, electrodes, technologists and physician oversight," said Dr. Davis. "You don't want to get a huge discount on equipment and then be charged $2,000 for electrodes."
4. Figure out how much patients will be billed. IONM testing often includes patient responsibility, but you want to make sure the patients won't be billed for $3,000 for the services. Decide whether you want patients to be billed and how much it would cost them.
"Some guys don't care if patients are billed and others don't want their patients to be billed for IONM," said Dr. Davis. "When they are billed, you want to make sure it will be $300 to $500."
5. Know which payors you can bill technical components. Some payors will allow you to bill for technical components separately. "For workers compensation, you can bill for those technical codes," said Dr. Davis.
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