EMG & NCS
Electromyography and Nerve Conduction Studies evaluate conditions involving the nerve and muscles. Contracted electrodiagnostic consultations are performed entirely by Board certified physicians (Physiatrists or Neurologists) who contractually agree to follow AANEM guidelines, thereby arriving at the accurate dx without excessive and often time unnecessary testing which will only increase cost and patient discomfort. Our physicians are encouraged to use techniques and adequately educate the patients to minimize anxiety and make the exam an experience with minimal discomfort. An MRI is an image of the anatomy whereas the EMG/NCS determines the health status of the nerve and muscle. EMG’s are frequently used to determine the presence and severity of conditions such as carpal tunnel syndrome, cervical or lumbar radiculopathies and generalized peripheral neuropathies.
Magnetic Resonance imaging (MRI) uses a strong magnetic field and radio wave energy to illustrate internal organs and body structures. MRI illustrates many diagnosis’ that cannot otherwise be obtained through an X-Ray or CT scan.
CT stands for Computed Tomography, and is essentially a specialized X-Ray. This computer takes separate x-ray illustrations and combines them into one very detailed picture. They are also referred to as CAT (Computerized Axial Tomography) scans, signifying the recorded tomogram sections at the various different levels of the body.
Contracted interventional physicians are well trained and experienced at performing many different types of injections. They are primarily therapeutic (to reduce pain) but oftentimes diagnostic (to confirm or rule/out a diagnosis). These injections are performed only when requested by a physician and are directed by the patients diagnosis. Typical injection sites include cervical or lumbar epidurals, facet joints, SI joint, and sympathetic blocks. They are done with imaging to ensure that the injected medication reaches the intended site. Patients are asked to rate their pain both pre and post injection. Repeat injections are only completed when asked by the referring physician and performed only when the patient meets our strict guidelines.
IME’s and Second Opinions
Independent Medical Evaluations and second opinions are often requested to assist in matters of dispute. The referral source needs to be identified with the examiner and the reason for the exam should be discussed with the patient as well. The physician is not entering into a treatment relationship with the patient. To maintain an unbiased attitude, there is no patient-physician relationship established. The physician is provided with the history and medical records to review, obtains a verbal history from the patient, and performs a pertinent physical exam. She/he then answers the medical questions raised by the referral source by generating a report which details their findings. Most often, these exams are scheduled to address the issues of causation. To do so, an accurate diagnosis has to be made. Questions regarding previous and future treatments needs are also often addressed.
In situations involving both Workers’ Compensation claims and SSDI disputes, the question of disability is often the subject of referral. Disability is the alteration of a person’s capacity to meet personal, social, or occupations demands or statutory requirements because of impairment. Disability is a relational outcome, contingent on the environmental conditions in which activities are performed. Whereas impairment is a loss, loss of use, or derangement of any body part or organ system, its effect on the inability to perform functionally is disability. Diagnosis is instrumental in determining disability.
Similar in nature and need to that of a second opinion or IME, a record review request may be sufficient to obtain sought after clarification on a case. These reviews are appropriate when the physical evaluation of the patient is not required nor would the exam provide any new or clarifying information to the physician. Examples of record review cases would be a Workers’ Compensation case where apportionment regarding different injury dates may be in question.
PPI or PPD Evaluations (Permanent Partial Impairment or Permanent Partial Disability)
Impairment is defined as a significant deviation, loss or loss of use of any body structure or function in the individual with a health of use of any body structure or function in individual with a health condition, disorder or disease. Impairments are determined as a percentage of the body part involved and then converted to a percentage of the whole person. An injury may result in an impairment from 0 to 100% of the whole person depending on the severity of the condition. Impairment ratings are defined by anatomic, structural, functional and diagnostic criteria. An accurate exam is also important in determining impairment as is the specific diagnosis. Ultimately the system for determining impairment should be reliable so that different raters arrived at consistent impairment ratings when assessing the same individual.
To achieve consistency the American Medical Association has been publishing The Guides to Evaluation of Permanent Impairment since the 1950s. Every seven years a new edition is printed. The most recent edition is the Sixth Edition published in 2008. This addition continues to emphasize diagnosis as a key contributor to determining the impairment rating. Some jurisdictions require the use of specific references for determining impairment.
Generally, impairment should not be determined until the patient has reached a point of maximum medical improvement (MMI). Until the patient reaches a point of maximum improvement, the impairment may change.
When determining impairment the physician should cite the reference and include the page or tables that were used in calculating the percentage. Furthermore if a body part is converted to a larger part or whole person the methodology needs to be described.