EMG worth while?

[Hockeyfan23]

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Hey all

5 years out from training. Just started in private practice and there is high demand for EMG/NCS from local providers. Wondering a couple things…

1) is it even worth it with current reimbursements the way they are? Would love to hear from seasoned vets.

2) haven’t touched an EMG since residency. Besides re-reading Preston And Shapiro front to back is there any other good and fast resources available? Any online courses people would recommend?

Thanks!

 

[JBM16BYU]

Thanks for reaching out in the forum as these are great questions. I will answer the second. Preston and Shapiro is a great book and reference. AANEM has workshops and sessions to further one’s EMG skills and would be a great resource as well. AAPM&R has a yearly workshop called EMG ReBoot camp which is specifically for people in your shoes who are into their own practice and out of EMG practice but hoping to revamp their skills. I highly recommend this course which is held annually at the conference.

As someone who receives a lot of second opinion questions for repeat EMGs from outside practices, oftentimes many with vastly different diagnoses attached to them, EMGs can be straight forward but there are many that are unfortunately misinterpreted or poorly performed and alot of unnecessary surgeries and treatments are done because of these… I caution jumping in feet first without revamping those skills. Just my 2 cents.

 

[neurolddoc]

The reimbursement for EMG/nerve conduction studies is not what it used to be. Currently in my region, Medicare reimbursement rates for 95886 which is EMG 2 extremities , and 95910, 7–8 nerve conductions, are $114.10 and $209.33 respectively. These are for global services including both professional and technical portions. Your reimbursement will vary by region. Commercial insurance may pay less, or sometimes a lot more depending on your area.

In our practice, we have technicians to do the nerve conduction studies and the physician then goes in to do the EMG.

Bottom line, the EMG portion of the reimbursement is not significantly different than in office visit. The nerve conduction reimbursement will cover the cost of your tech time plus a little margin.

Do not order the yacht, though.

 

[sloh]

The reimbursement for EMG/nerve conduction studies is not what it used to be. Currently in my region, Medicare reimbursement rates for 95886 which is EMG 2 extremities , and 95910, 7–8 nerve conductions, are $114.10 and $209.33 respectively. These are for global services including both professional and technical portions. Your reimbursement will vary by region. Commercial insurance may pay less, or sometimes a lot more depending on your area.

In our practice, we have technicians to do the nerve conduction studies and the physician then goes in to do the EMG.

Bottom line, the EMG portion of the reimbursement is not significantly different than in office visit. The nerve conduction reimbursement will cover the cost of your tech time plus a little margin.

Do not order the yacht, though.

How long does it take you to finish these exams?

 

[Zendo]

The reimbursement for EMG/nerve conduction studies is not what it used to be. Currently in my region, Medicare reimbursement rates for 95886 which is EMG 2 extremities , and 95910, 7–8 nerve conductions, are $114.10 and $209.33 respectively. These are for global services including both professional and technical portions. Your reimbursement will vary by region. Commercial insurance may pay less, or sometimes a lot more depending on your area.

In our practice, we have technicians to do the nerve conduction studies and the physician then goes in to do the EMG.

Bottom line, the EMG portion of the reimbursement is not significantly different than in office visit. The nerve conduction reimbursement will cover the cost of your tech time plus a little margin.

Do not order the yacht, though.

Thank you for sharing. How is the reimbursement for EEGs? Do general neurologists in your practice read a lot of them, or are they only read by epilepsy/CNP trained docs?

Also, if you wouldn’t mind sharing, what component of your practice has been most beneficial or lucrative? I’ve heard of some private practices even closing down due to not covering overhead, so this would be helpful to learn.

 

[JBM16BYU]

Full disclosure, I am not in private practice nor am I a neurologist (neuromuscular physiatry). I also apologize in advance if this sounds idealistic, but take this as general advice. However, I would recommend some internal reflection when considering your practice / future practice. As a sub specialist and proceduralist in a niche clinical area, I would highly recommend for those early in careers, or still in training, to discover what you are passionate about and what you are good at. Unlike in some non-medical careers where it may be difficult to pursue a passion and make a living, we are blessed in medicine that you actually can. If you do your job well, are truly interested in what you are treating, and, from a procedural standpoint, are truly exceptional at the procedures you perform, referrals will come. If you communicate well with those that refer to you and appropriately refer to others when something is out of your depth, referrals will continue to come. Whether it is EMG, EEG, neurotoxin injections, neuromuscular ultrasound, occipital nerve blocks, etc., if you perform comprehensive tests, diagnose appropriately, and have good hands on skills (for those requiring that), then referrals for these procedures will continue to come. I would not chase money for procedures in which you are only adequate, but rather, either seek to improve performance of these procedures to become exceptional or concentrate on those in which you are exceptional. A poorly performed or interpreted EMG/EEG is not helpful (and may be harmful). Poorly dosed or localized neurotoxin injections are not helpful (and may be harmful). Hope this is helpful.

 

[neurolddoc]

Thank you for sharing. How is the reimbursement for EEGs? Do general neurologists in your practice read a lot of them, or are they only read by epilepsy/CNP trained docs?

Also, if you wouldn’t mind sharing, what component of your practice has been most beneficial or lucrative? I’ve heard of some private practices even closing down due to not covering overhead, so this would be helpful to learn.

EEG reimbursement is good. and provides a significant revenue stream. All read. If there is something unusual, They can ask one of the CNP boarded docs.

Our practice is very well well run. Our neurologists see a lot of patients and have very good reputations. We have busy neurodignostic, neurovascular and vestibular labs. Our revenues exceed our overhead by a substantial margin.