Intraoperative monitoring

[Abacus1050]

Intraoperative neurophysiological monitoring seems like a really interesting speciality. Is Neurology the 'best' route to eventually do this type of work (vs. anaesthesiology for instance). Also, within Neurology am I correct in assuming that this would be accomplished through a clinical neurophysiology fellowhship?

Does anyone have any insight into this type of work? (demand, lifestyle, challenge, reward)

Thank you for your help!

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[neurologist]

Intraoperative neurophysiological monitoring seems like a really interesting speciality. Is Neurology the 'best' route to eventually do this type of work (vs. anaesthesiology for instance). Also, within Neurology am I correct in assuming that this would be accomplished through a clinical neurophysiology fellowhship?

Does anyone have any insight into this type of work? (demand, lifestyle, challenge, reward)

Thank you for your help!

This is indeed a growing field.
Intraoperative EEG is being used in carotid endarterectomy cases; evoked potentials are used in spine and skull base cases.
Generally, the person actually in the OR is not the neurologist, but a neurophysiology tech. The neurologist is either elsewhere in the hospital "on-call" if something happens, or possibly following along on a remote screen if they have that capability.

Neurophysiology fellowship is the way to go if you are interested in doing this. I know there are a few neuro groups who specialize in this area now, and I've seen a couple of journal ads specifically for intra-op monitoring neurologists, but for the most part it is still a very small minority who can make a full time living off just intra-op monitoring; it's largely just another of several services you can provide. No idea what the $$ potential is. Lifestyle is obviously tied to the OR schedule, but again, it's most likely not going to be the only thing you do day in and day out.

 

[2ndyear]

I've always wondered who exactly bills for this and who is responsible for the results. I'm an anesthesia resident, and we see quite a bit of SSEP/MEP for scoliosis correction. Some EEG for carotids, but we push to do them awake if possible (after a cervical block by us). Usually the techs will just tell us when they have lost a signal. Since there are a plethora of cords and wires dangling, they usually work on these first. I've only had a few requests to decrease volatile anesthetic, usually because their amplitude/latency is getting altered. But I've never had a big moment where they tell me we're getting ischemic.

So what are the requirements for an MD to bill for this? Is it being present in the OR, or does a neurologist analyze the study afterwards like polysomnography? It differs quite a bit from sleep though, of course, because you are looking for acute reductions in blood flow that will alter treatment on the spot. But the techs aren't billing for this. I know only one anesthesia group that does it's own neuromonitoring.

 

[neurologist]

I've always wondered who exactly bills for this and who is responsible for the results. I'm an anesthesia resident, and we see quite a bit of SSEP/MEP for scoliosis correction. Some EEG for carotids, but we push to do them awake if possible (after a cervical block by us). Usually the techs will just tell us when they have lost a signal. Since there are a plethora of cords and wires dangling, they usually work on these first. I've only had a few requests to decrease volatile anesthetic, usually because their amplitude/latency is getting altered. But I've never had a big moment where they tell me we're getting ischemic.

So what are the requirements for an MD to bill for this? Is it being present in the OR, or does a neurologist analyze the study afterwards like polysomnography? It differs quite a bit from sleep though, of course, because you are looking for acute reductions in blood flow that will alter treatment on the spot. But the techs aren't billing for this. I know only one anesthesia group that does it's own neuromonitoring.

EEG and SSEP billing has 2 "components": a "technical component" (i.e, the tech wiring up the patient and doing the study) and a "professional component" (the neurologist interpreting the study). In both EEG and SSEP, it's pretty obvious what constitutes the "technical component": it's the tech in the OR. With EEG, we read them after the surgery/EEG is complete in order to generate the "professional component." I admit to being uncertain how exactly the professional component of SSEP's gets billed.

 

[Yoyomama88]

how is the reimbursement for neurologists in the OR for DBS or epilepsy surgeries? Can neurologists do a few operations a week?