Definition of Real Time Onsite

The American Medical Association’s (AMA) Current Procedural Terminology Professional Codebook includes a description of how nerve conduction studies should be performed.  The description states that the “Waveforms must be reviewed on site in real time…” (emphasis added).  In addition, it states that the “Reports must be prepared on site by the examiner, and consists of the work product of the interpretation of numerous test results…along with summarization of clinical and electrodiagnostic data, and physician or other qualified health care professional interpretation.”¹   The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) has developed the following definitions of onsite and real time to assist providers in understanding codes 95905-95913 and payers to determine if the rules established for those codes are being followed.  
 

Onsite Definition

The use of the term “onsite” indicates that generating or reviewing a summary of the patient’s history and physical examination, execution of all of the nerve conduction studies and EMG examinations, analysis of the electrodiagnostic (EDX) data, and determination of the diagnoses for the patient are performed in the same location which is most commonly the EDX laboratory.²  The “Onsite” definition precludes the use of telemetry or other technologies that allow the EDX data to be transmitted to and interpreted at a location different from where the EDX study is performed. 
 

Real Time Definition

The use of the term “real time” with regard to nerve conduction studies indicates that information from the history and physical examinations are integrated*, the specific and tailored EDX study is performed, and the analysis of the waveforms are all done while the patient is present in the EDX laboratory.  An EDX study performed in “real time” is more sensitive and accurate since it allows the specific NCS and EMG tests performed to be interpreted and additional NCS or EMG studies be performed, if necessary, to further define the disorders which are present and final diagnosis (diagnoses) to be made before the patient leaves the EDX laboratory.  
 

Qualifications

It is the position of the AANEM that the needle EMG examination be performed by a physician (MD or DO) and that the physician perform or directly supervise a qualified technologist to perform the NCSs.  Further information can be found in AANEM’s position papers Who Is Qualified to Perform Electrodiagnostic Medicine³ and Proper Performance of Electrodiagnostic Medicine. ²
  
* Integration in the context of EDX studies describes how attributes of the history and physical examinations are used to design a specific grouping of nerve conduction studies and a specific selection of muscles to be evaluated during the needle EMG examination for each patient.  The EDX examination is therefore tailored to each patient.²