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Intraoperative monitoring

Discussion in 'Neurology' started by Abacus1050, Aug 8, 2006.

  1. Abacus1050

    Abacus1050 Member
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    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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  3. neurologist

    neurologist En garde
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    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.
     
  4. 2ndyear

    2ndyear Senior Member
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    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.
     
  5. neurologist

    neurologist En garde
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    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.
     
  6. gopens67

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

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