AANEM Practice News Express

AANEM News Express

Patient Safety: Needle EMG and the Risk of Pneumothorax

Needle EMG and the Risk of Pneumothorax

Patient Safety: Statins and Immune-Mediated Necrotizing Myopathy

A 66 year old man with hypothyroidism is referred for an evaluation of severe muscle pain and proximal leg weakness which started shortly after initiating simvastatin treatment. What is most helpful to differentiate a toxic necrotizing myopathy from an immune mediated necrotizing myopathy?

Patient Safety: NM Complications of Immune Checkpoint Inhibitors

Immune checkpoint inhibitors (ICPI’s) are monoclonal antibodies that target the immune checkpoints programmed death 1 (PD1), programmed death ligand 1 (PDL-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) on T cells and promote immune mediated destruction of cancer cells. They are used to treat a variety of cancers including breast, bladder, cervical, colon, lung cancer, Hodgkin’s lymphoma, melanoma, etc. ICPI treatment is associated with an array of immune related adverse events affecting many organ systems. Neurologic adverse events have also been reported.

Practice: CMS Releases Proposed Updates to Physician Fee Schedule and the Quality Payment Program

AANEM policy staff is diligently reviewing the 1,700+ page rule that was issued by the CMS on July 13, 2021. Here are a few highlights from the proposal. 

Patient Safety: Safety of DOACs in Needle EMG

Limited data is available regarding the risk of bleeding with EMG in patients taking DOACs. One small retrospective study looked at the risk of bleeding after EMG in this patient population and in those taking warfarin, using ultrasound of studied muscles. Nine patients out of the 58 included had hemorrhagic complications, six of which were classified as clinically relevant non-major bleeding and three as asymptomatic bleeding, with a higher incidence of hemorrhage in the DOAC group as compared to the warfarin group. No cases of major bleeding were found.

Patient Safety: EMG/NCS and Risk of Bleeding

Electrodiagnostic testing (needle electromyography) in patients with bleeding diathesis is associated with greater risk of bleeding when compared to general population. It is recommended that caution should be used when deciding on electrodiagnostic testing in patients with platelet counts less than 50,000 and INR greater than 1.5-2.0.

COVID-19 Vaccine: AANEM Publishes Guidance for Patients with NMDs

At the end of 2020, with announcement of the impending approval of not one but two vaccines against COVID-19, AANEM staff faced a sudden influx of phone calls and emails from members, nonmember physicians, and even some NM patients inquiring about the safety of such vaccines for NM patients. The AANEM Quality & Patient Safety Committee quickly took up the task of researching the data available on the COVID-19 vaccines, as well as looking at the safety and efficacy of vaccines in general in this patient population.

Changes to Office Visit Evaluation and Management Codes Coming in 2021: Your Questions Answered

In 2019, the CPT Editorial Panel approved changes that will significantly impact office and outpatient evaluation and management (E/M) codes.  These changes will only affect CPT codes 99202-99215 and will go into effect January 1, 2021.

AANEM Assists in Creation of New Codes to Account for Additional Services During Public Health Emergency

On September 8, 2020 the American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT) code set that includes two new code additions for reporting medical services required by the public health response to the COVID-19 pandemic.  The two additions have been approved for immediate use.

CMS Announces Option to Opt-out of MIPS for 2020

CMS announced that MIPS eligible clinicians will have the choice to opt-out completely or partially from the 2020 MIPS program by completing a hardship exemption application and indicating that it is due to the COVID-19 Public Health Emergency.