Anesthesiology pain and emgs ?

[soxman]

Can Anesthesiologists who do a pain fellowship train for and bill EMGs ? Or is this only limited to PMR and neurology ?

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[geauxg8rs]

I did gas then pain fellowship. We had some lectures from pmr about emg. That was the extent of my emg training. Hardly enough to understand it let alone do it or bill it.
I guess one might look to get more emg as a one year pain fellow? But you would be doing thst at the expense of your advanced pain procedures/training.

 

[soccerpunk600]

the pay for EMGs is ****. it wouldn't be worth your time.

 

[101N]

Short answer is no. No where near enough time & way outside scope of practice.

 

[cbest]

As a physiatrist starting my pain fellowship in July, I can assure you there wouldn't be enough time to learn both EMG and pain in one year!

 

[jonnylingo]

EMG/NCS took big hits January of 2013. Even if you learn it, it's tough to turn profit unless you have techs doing the NCS, and you do the EMG. If you don't have techs, one could argue you'd make better use of your time seeing a level 3 f/u than doing a single limb EMG.

 

[BobBarker]

The person I know who still does a lot of EMGs does a level 4 new patient with the EMG. So it works out ok and they actually do an evaluation and will make other treatment recommendations

 

[lobelsteve]

The person I know who still does a lot of EMGs does a level 4 new patient with the EMG. So it works out ok and they actually do an evaluation and will make other treatment recommendations

Yes, I hear Radiologists are also doing this with MRIs.

 

[deleted472101]

Yes, I hear Radiologists are also doing this with MRIs.

Really?

 

[lobelsteve]

Really?

Nope. But just as dirty. Im pmr/pain and send my emg's out and expect little talk, bo consult, and no dx told to my patients. I will take the data and waveforms and out it in clinical context. Extension of the exam....but my exam.

 

[Taus]

Nope. But just as dirty. Im pmr/pain and send my emg's out and expect little talk, bo consult, and no dx told to my patients. I will take the data and waveforms and out it in clinical context. Extension of the exam....but my exam.

I would think its routine for the electromyographer to tell the patient their electrophysiologic diagnosis immediately after the test. I certainly do. Also of course do my own focused HnP to correlate and modify test as indicated. I don't give really detailed answers, but if they have moderate cts they walk out knowing that. I don't offer treatment recs, but if patient asks I'll respond with a very quick generic answer and then defer to treating physician.

 

[jonnylingo]

The person I know who still does a lot of EMGs does a level 4 new patient with the EMG. So it works out ok and they actually do an evaluation and will make other treatment recommendations

It's fraud to bill for EM code unless there is referral for consult/eval. NCS/EMG billing has a focused H&P "built in", so to bill over and beyond this requires a consult request.

 

[jonnylingo]

I don't discuss results with patient. I flatly let the patient know the referring doc will use this information to help with his diagnosis and treatment plan, and that I'm seeing only a piece of the puzzle.

I do this for 2 reasons... first, EMG/NCS don't pay well enough for me to spend much time explaining diagnosis and treatment options. Second, EMG/NCS findings are interpreted in context of other clinical, radiological, and lab findings. I'm not looking at the entire history when doing the electrodiagnostics, so my only job is to report findings to referring provider. I act as an extension of his/her physical exam only.

 

[bedrock]

I stopped doing EMGs altogether, because I never liked doing them to start with , and now it looks like I need to bill a level 4 consult just to make them fincially viable so I see no reason to ever do a EMG again.

The OP anesthesia fellow would be crazy to waste time with EMGs.

 

[SSdoc33]

first of all, yes, you can bill for EMG / NCS. it would help to know what you are talking about with it, and getting good at them takes lots of studies and lots of years. OTOH, neurologists who get little or no EMG training come right out of residency perform and bill for EMG/NCS because they are starved for procedures. bottom line: dont believe the results of any EMG coming from neuro

 

[SSdoc33]

Nope. But just as dirty. Im pmr/pain and send my emg's out and expect little talk, bo consult, and no dx told to my patients. I will take the data and waveforms and out it in clinical context. Extension of the exam....but my exam.

i call BS. you want to tell the patients a diagnosis, then you perform the EMG. this isnt a blood test. there is nuance and subjectivity. you can look at a waveform, but without knowing it was on the motor point, or measured correctly, then it means nothing.

AANEM would disagree with you, and say that billing a consult is reasonable in many (dare i say most) clinical scenarios.

 

[lonelobo]

I was taught by Dr. Dumitru that an EMG is an extension of your physical exam, but hey what does he know?

 

[bedrock]

This is now a pain tray situation where EMG payment has been cut so much it's ridiculously unfair and I would argue that physicians are justified in billing a consult with every single EMG to make up for the money that was unjustly taken from them in the EMG cuts.

I know several very good thorough outpatient PMR practices that had to close just because of the EMG cuts.

 

[Ducttape]

so 2 wrongs do make a right...

hmm, ill have to revisit everything i learned in elementary school.