AANEM Connect

Hi Everyone,

I have a question for the AANEM Community. 

I am a PM&R Physician who performs EMG/NCS and am interested in how other practices/ institutions approach collaboration between physiatry and neuromuscular neurologists. 

Occasionally I perform initial EDX studies referred by orthopedic/ NSGY/ or primary care providers that are technically adequate for the initial clinical question, but occasionally findings are unexpected or disproportionate to the patient's exam and/ or imaging findings. (for example, more extensive widespread denervation or atypical polyneuropathies).

In these situations, my pracice has been to document the findings, my differential diagnosis, and referral to neuromuscular specialist when I feel a broader neuromuscular evaluation and work up is warrented. However, there can be a quesiton of when the performing EDX physician should be referring to a  neuromuscular physician who may ultimately want additional EDX testing (whether to extend study or repeat). 

I am interested to hear how other institutions handle this scenario. 

1. When initial EDX study is adequate for the original referral question but revealed unexpected or clinically discordant findings, do you order work up or refer to neuromuscular neuro in the case more extensive lab work or imaging is indicated?

2. Is there an established pathway or agreed upon criteria for these referrals?

3. What challenges are there with regard to billing/ reimbursement when neurology wants to repeat or extend the initial EDX study?

4. Any other docummentation, communication, or referral practices that help avoid unnecessary duplication of studies while still allowing for initial clinical evaluation and subsequent subspecialty evaluation with repeat EDX if indicated.

My goal is to foster good collaboration between specialists to make sure patient get appropriate level of care and in a timely maner. Looking forward to this discussion. 

Thank you!