Frequently Asked Questions

 

Frequently asked questions related to the EMG Solutions provision of EMG and nerve conduction studies.

We provide electrodiagnostic testing services including nerve conduction studies (NCS) and needle electromyography (EMG).

  • Physical therapists who provide electrodiagnostic testing services are required to complete a rigorous didactic curriculum, 500 clinical studies and 2000 hours of testing in order to qualify to sit for an examination administered by the National Board of Medical Examiners (NBME).
  • Currently, among all physical therapists in the United States, only 166 are board certified to provide electrodiagnostic testing services.

Physical therapists who have completed their board certification are recognized as qualified providers of clinical EMG/NCS by major insurance carriers including Medicare and Blue Cross. Physical therapists have been specifically recognized and listed by Medicare since 2001 as qualified providers of electrodiagnostic testing.

  • The providing physical therapist, as a qualified practitioner, reads the report and writes the conclusion.
  • It is important to remember that the physical therapist does not diagnose the condition simply based on the results of the study. Rather, the results describe the state or condition of the peripheral nerve and associated muscle in order to assist the referring physician in their diagnosis.

In over 50 years of EMG/NCS testing provided by physical therapists, there has never been an insurance claim filed against a board-certified physical therapist providing electrodiagnostic testing services.

The report is usually provided on the same day but in some cases may take up to 24 hours.

EMG solutions is largely self-contained. We bring the equipment, electrodes and needles. The clinic provides a treatment room and table (physical therapy clinics work very well), gauze pads and alcohol.

We are accustomed to providing the service in multiple clinics and recognize the demand will vary from one clinic to another and even from one month to another. We have the ability to scale the service depending on the demand. A small satellite office might need this service for half a day every two weeks but a busy clinic may require a full day (or more) of service on a weekly basis.

We are a contract based EMG testing company. Electromyography, or EMG, is paired with nerve conduction studies, NCV, to evaluate the integrity of the peripheral nervous system and how it interacts with the muscles. We provide in-house services on a referral basis.

Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets. An EMG uses tiny devices called electrodes to transmit or detect electrical signals. During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle. A nerve conduction study, another part of an EMG, uses electrodes taped to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points. EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.

If you have leg/arm pain or numbness, you may have these tests to find out how much your nerves are being affected. These tests check how well your spinal cord, nerve roots, nerves, and muscles that control your legs and arms are working.

Medications
Mestinon: This medication must be discontinued for 12 hours prior to the study
All other medications are fine to continue taking
Please Refrain from wearing Lotions, Creams, Perfumes, and Oils as these can these can interact with the equipment not allowing it to work properly.
Jewelry will have to be removed prior to testing
Please wear loose fitting clothing or athletic wear so that your legs, arms, neck, and back can easily be accessed.
The test will take approximately one hour

A nerve conduction study (NCS), also called a nerve conduction velocity (NCV) test–is a measurement of the speed of conduction of an electrical impulse through a nerve. NCS can determine nerve damage and destruction. During the test, the nerve is stimulated, usually with surface electrode patches attached to the skin. Two electrodes are placed on the skin over the nerve. One electrode stimulates the nerve with a very mild electrical impulse and the other electrode records it. The resulting electrical activity is recorded by another electrode. This is repeated for each nerve being tested. The nerve conduction velocity (speed) is then calculated by measuring the distance between electrodes and the time it takes for electrical impulses to travel between electrodes.

CAPTE instruction in electrophysiological testing is in the basic professional education curriculum. NCS/EMG is described as part of physical therapy practice of tests and measurements in all four practice areas of the Guide to Physical Therapist Practice. Minimum eligibility requirements for ABPTS certification in Clinical Electrophysiology require 2,000 hours of direct patient care in the specialty area within the last 10 years, 25% (500) of which must have occurred within the last three (3) years. The applicant must include evidence of performing a minimum of 500 peer reviewed, complete electroneuromyography examinations during those hours. The American Board of Medical Examiners administers certification testing.

Medicare, the largest payer in the United States, reimburses for NCS/EMG provided by physical therapists. On April 19, 2001, the Centers for Medicare and Medicaid Services issued Program Memorandum B-01-28, which states that physical therapists who are board-certified in clinical electrophysiology by the ABPTS may perform, and be reimbursed for, NCS/EMG without the supervision of a physician. In September 2001, CMS expanded this policy to cover NCS/EMG services provided by physical therapists who are not ABPTS certified if they had provided NCS/EMG services to Medicare patients prior to May 1, 2001. This policy was renewed in December 2010. A new CMS transmittal was issued in March 2013, with final policy established and published in the Medicare Benefit Policy Manual in 2014.

Billing and Collecting

  • The Clinic is responsible for the billing and collecting for the services provided. The providing physical therapist is credentialed by the clinic and all benefits are collected by the clinic.
  • EMG Solutions will provide all necessary documentation for the credentialing.
  • EMG Solutions will submit a monthly invoice to The Clinic based on services provided.

Patient Flow

  • EMG Solutions goal is to expedite scheduling, testing and report turnaround. Depending on caseload, we increase availability.
  • We plan to see one patient per hour and, depending on clinic hours, usually see nine patients in a full day (we don’t stop for lunch).
  • Usually, an EMG schedule is added to the clinic schedule based on our agreed dates and times, and EMG referrals are placed on that schedule. On the scheduled date, we see the patient, and complete the billing and other documentation. Reports are completed the same day the study is performed. Usually there is a designated person as our point of contact for the schedule, billing and documentation.
  • Depending on referrals, we can increase or decrease availability.

Treatment Space

  • Depending on the clinic, we usually perform the testing in an exam room using a plinth. In some locations where physical therapy is co-located, we provide the service in the physical therapy department. Most treatment rooms are of sufficient size for us to set up our equipment and see the patient.