Is Clinical Neurophysiology About to Die?

For some of us, the future of clinical neurophysiology looks

very bleak. Dark clouds seem to be assembling on every

horizon. After all, isn't it the same technology except with a

few more bells and whistles that we knew from 50 years ago?

Aren't reimbursements likely to drop and won't there be

increasing regulations and restrictions on clinical practice?

Aren't there fewer young people going into the field and

doesn't our group appear to be aging as a whole? What is

fundamentally new and exciting? Maybe it is time to pack it

in. A Shakespeare sonnet laments that "on the ashes of his

youth doth lie… consumed by that with which he was

nourished by." Is that us and clinical neurophysiology? I

don't think so. In fact, rather than a field headed for senescence, there is a general

excitement and energy about the field that is palpable and the scientific advances have

never been more promising. Let's look at the evidence.

This year's scientific program, crafted by Cecil Hahn and Francis Walker, is better than

ever. Many aspects of central and peripheral clinical neurophysiology have

representation with very stimulating topics. The speakers are stellar and there will be

ample opportunity for lively exchanges. The courses, assembled by Bill Tatum, are

largely composed of an "all-professor" faculty of talented speakers whose passion for

their work is evident in every aspect of their presentations. Through years of

meticulous, diligent work they are poised to pass along all sorts of clinical pearls to

those eager to learn. There were a record number of abstracts submitted for the program

- more than double any previous year! Our membership is more diverse and we're

seeing a fresh infusion of young talent. Exciting collaborative projects have been

developed, great new special interest groups have formed, and new professional

connections made. We continue to be a society of friendly, cordial, and very

approachable individuals. Where else could you walk up to the authors of all of the

most prestigious books in the field and start a casual conversation at the drop of a hat?

Have you noticed the nature of the submissions to the journal? In my view they are

getting better and better. I'm finding more articles that immediately pique my interest,

have genuine value and will contribute to clinical care. Thanks to the stewardship of

John Ebersole it is on an even better financial footing and its scientific impact continues

to rise.

What about clinical practice? In my area, digital technology has transformed a test that

some regarded as destined for the trash heap to a vital test that provides timely and

(Continued on page 2)

Vo

lum

e 4

, Is

sue 1

Ja

nu

ary

, 2

01

2

Clinical Neurophysiology News Newsletter of the American Clinical Neurophysiology Society

Newsletter Editor Jonathan C. Edwards, M.D

2012 Annual Meeting

and Courses

February 7-12, 2012

Marriott Rivercenter

San Antonio, TX

Program Co-Chairs:

Cecil Hahn, M.D. &

Francis Walker, M.D.

Course Chair:

William O. Tatum IV,

D.O.

Visit www.ACNS.org to

register and make your

hotel reservation.

Message from the President

Douglas R. Nordli Jr., M.D

Message from the President (continued) American Clinical

Neurophysiology Society

2011-2012 Council Members

PRESIDENT

Douglas R. Nordli, Jr., M.D.

Children's Epilepsy Center

Chicago, IL

1ST VICE PRESIDENT

Susan T. Herman, M.D.

Beth Israel Deaconess Medical Center

Boston, MA

2ND VICE PRESIDENT

Frank W. Drislane, M.D.

Beth Israel Deaconess Medical

Center

Newton, MA

SECRETARY

Aatif M. Husain, M.D.

Duke University Medical Center

Durham, NC

TREASURER

Stephan Schuele, M.D., M.Ph.

Northwestern University Neurology

Chicago, IL

IMMEDIATE PAST PRESIDENT

Peter W. Kaplan, MB, FRCP

Johns Hopkins Medical Center

Baltimore, MD

PAST PRESIDENT

Gareth J. Parry, M.D.

University Minneapolis Neurology

Minneapolis, MN

COUNCIL MEMBERS

Jonathan C. Edwards, M.D.

Medical University of South Carolina

Charleston, SC

Terrence D. Lagerlund, M.D.

Mayo Clinic

Rochester, MN

Suzette LaRoche, M.D.

Emory University Medical Center

Atlanta, GA

Jamie R. Lopez, M.D.

Stanford University Neurology

Stanford, CA

Suraj Ashok Muley, M.D.

St. Joseph's Hospital and Medical

Center

Phoenix, AZ

Piotr W. Olejniczak, M.D.

Louisiana State University Health

Sciences Center

New Orleans, LA

William O. Tatum IV, D.O.

Mayo College of Medicine

Jacksonville, FL

Francis O. Walker, M.D.

Department of Neurology

Winston-Salem, NC

Elizabeth J. Waterhouse, M.D.

Medical College of Virginia Medical

Center

Richmond, VA

highly relevant information at a great value for the dollar. Yes, we've seen welcome

improvements in imaging, and each iteration of MR technology brings something of

additional value to patient care, but none of these compare with the quantum gain in

value of the video EEG to the field of pediatric epilepsy. I can't tell you how many

antiquated assumptions and preconceived notions about epilepsy in children have

been shattered by careful review of video EEG data. In my center, like many

throughout the world, we review the most interesting video EEG findings from the

previous week in an hour long conference. It is the greatest source of continuing

education I've ever had. The ability to actually capture the events in question,

analyze them with polygraphic recordings, and correlate all of this with a variety of

digital tools has proven to be immensely rewarding, both for patient care and also

for professional enlightenment. I see similar changes in the ICU continuous

monitoring and intraoperative monitoring. We have an opportunity to build on the

solid foundation of our predecessors with a new technology that allows us to sift

through massive amounts of data in record times so that we can cut quickly to the

most relevant portions and help our patients.

So, there are lots of reasons to be optimistic and excited, but what about the practice

challenges, the regulations, and the poor reimbursement? Oh, the endless scuffles

with administrators, which seem to number in the legions. Each time you eliminate

some obstacle to care doesn't it seem like two others rear their ugly heads, like a

grotesque Hydra? I've only been at this for about 22 years, but during that whole

time it seems like this has been a constant droning noise, always there in the

background. It doesn’t seem to change or go away, so I’m starting to ignore it.

Thank goodness we have strong allies, like Marc Nuwer who keep beating Hydra

back into submission so that we can continue the practice we enjoy, help our

patients, and improve our discipline.

I won't lie. Things looked a little bleak some years ago, but fortunately, new

vitality and energy has come to our field and our society. There are many reasons

to set aside our concerns and to be optimistic for a bright future. Now, in short, I

still see the ash heap, but arising from it is the phoenix!

Doug

President, American Clinical Neurophysiology Society

Journal of Clinical Neurophysiology

Dr. John Ebersole, Journal Editor, welcomes

suggestions and guest editors for special issues of

the Journal. Potential authors may now submit

their manuscript online at

www.EditorialManager.com/JCNP.

2011 Neurophysiologic Intraoperative Monitoring and ICU EEG Monitoring Courses

After the huge success of last November's Neurophysiologic Intraoperative Monitoring Course in Baltimore, the

American Clinical Neurophysiology Society (ACNS) decided to hold mid-year courses again this year. In

September, 2011, comprehensive two-day courses on Intraoperative Monitoring and ICU EEG Monitoring were

held at the Sheraton Atlanta in Atlanta, Georgia.

Attendees ranged from neurophysiology trainees to experienced neurologists and neurophysiologists as well as

many electroneurodiagnostic technologists. The NIOM Course had 61 attendees and the ICU EEG Monitoring

Course had 54 attendees. Speakers included experts in the field of neurophysiology from many of the top IOM

and EEG monitoring institutions in the country. Participants attending the Atlanta courses came from all over

the United States, Canada, the United Kingdom and Saudi Arabia.

Several vendors were also on hand displaying their equipment and some presenting lectures. The ACNS

graciously thanks the following sponsors and vendors for their support: Cadwell, CareFusion, Compumedics,

Medtronic, Natus Medical, Nihon Kohden, Persyst and UCB Inc.

The Saturday evening reception was very well-attended and allowed participants to socialize among themselves

and with the vendors.

In case you weren't able to attend the mid-year courses, don't miss the ACNS Annual Meeting and Courses

which will take place February 7 through February 12, 2012, at the Marriott Rivercenter in San Antonio where

both IOM and EEG monitoring courses will be held in addition to other courses on EMG, Sleep, EMG and EEG

Technology and Applied Autonomic Neurophysiology as well as a Nerve Conduction Workshop and EP

Reading Session.

Vo

lum

e 4

, Is

sue 1

A

CN

S N

ew

slett

er

AMERICAN CLINICAL NEUROPHYSIOLOGY SOCIETY

2012 ANNUAL MEETING AND COURSES

FEBRUARY 7-12, 2012

MARRIOTT RIVERCENTER* - SAN ANTONIO, TEXAS

*Please note that some early Courses will be held at the Marriott Riverwalk,

located across the street from the Marriott Rivercenter.

Click on the picture at right to view the

preliminary program.

You can also visit the ACNS Website

(www.ACNS.org) to view or download

the Preliminary Program, register for the

Annual Meeting and/or Courses and to

make your hotel reservation.

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

ACNS PROFESSIONAL DEVELOPMENT MENTORING PROGRAM

Friday, February 10, 2012

6:45 p.m.

This year’s Annual Meeting will include a new professional development session for clinical neurophysiologists.

The program is targeted to neurology residents, clinical neurophysiology fellows, and junior faculty at the

instructor or assistant professor level. Attendees will be matched with a clinical or research mentor in clinical

neurophysiology for a brief one-on-one mentoring event at the beginning of the ACNS Attendees Reception on

Friday. The goals of the program are to foster career development in clinical neurophysiology, encourage active

participation in the many activities of ACNS, and facilitate networking.

Please sign up on the Annual Meeting and Courses registration form to be matched with a mentor, or to volunteer

to serve as a mentor, or contact Marie Westlake, Associate Executive Director, by email at ACNS@ssmgt.com or

phone at 860-243-3977.

THIRD ANNUAL ACNS NEUROPHYS BOWL

Co-Chairs, Drs. Lawrence J. Hirsch, M.D., and Mark A.

Ross, M.D., invite you to participate in the

Third Annual ACNS NEUROPHYS BOWL

which will take place on Friday, February 10, 2012, from

5:30 p.m. to 6:45 p.m., at the Marriott Rivercenter in San

Antonio, Texas.

Come cheer on your colleagues as they test their knowledge

of clinical neurophysiology!

To participate as an individual or with a team, download the

form from www.ACNS.org and email to

ACNS@ssmgt.com or fax to 860-286-0787.

ATTENTION FELLOWSHIP DIRECTORS!

The Consortium of Clinical Neurophysiology Program Directors (CCNPD) will meet

Saturday, February 11 at 12:30 p.m. to 1:30 p.m.

at the Marriott Rivercenter in Conference Rooms 13/14.

Please plan to attend.

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

Invitation to Exhibitors and Sponsors

Opportunities for exhibitors and sponsors are available for the 2012 Annual Meeting and Courses of the

American Clinical Neurophysiology (ACNS), to be held February 7 - February 12, 2012, at the Marriott

Rivercenter in San Antonio, Texas. Show dates are February 10 and February 11, 2012.

Sponsorships of non-CME functions, such as meals and receptions, are available. The third annual Neurophys

Bowl will take place on Friday, February 10, beginning at 5:30 p.m., immediately preceding the attendees'

reception.

As always, all food functions and poster sessions will be held in the Exhibit Hall. A detailed exhibit brochure can

be found at the link below, along with the meeting schedule.

For questions, please contact Marie Westlake, Associate Executive Director, at ACNS@ssmgt.com or 860-243-

3977.

Click the HERE to Access the Full Exhibitor Brochure!

AMERICAN CLINICAL NEUROPHYSIOLOGY SOCIETY

2013 Annual Meeting and Courses

February 5 - February 10, 2013

Miami Marriott Biscayne Bay

Miami, Florida

Scientific Program Co-Chairs

Jonathan C. Edwards, M.D., and Mark Hallett, M.D.

Proposals are being sought for Symposia, Clinical Workshops and other didactic and interactive sessions for the 2013

American Clinical Neurophysiology Society (ACNS) Annual Meeting which will take place at the Miami Marriott

Biscayne Bay in Miami, Florida. This call for proposals is to enhance the opportunities for clinicians and investigators

to introduce advanced scientific or clinical topics for those interested in the field of clinical neurophysiology.

Proposals should include a title, outline of the session, list of moderator and speakers, and an overview of the objectives,

scientific content, target audience and educational needs. Format for proposals of various types is listed below.

(Continued on page 6)

Call for Proposals for Symposia, Clinical Workshops,

and Other Didactic and Interactive Sessions

SUBMIT ONLINE: www.ACNS.org

SUBMISSION DEADLINE IS MONDAY, JANUARY 30, 2012

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

AMERICAN CLINICAL NEUROPHYSIOLOGY SOCIETY

2013 Annual Meeting and Courses

Professional Practice Gaps

Programs of the ACNS are designed to address the following professional practice gaps and submissions

will be evaluated with reference to these gaps:

Gap #1. Emerging Areas of Practice. Neurological intraoperative monitoring (NIOM) and intensive care

unit EEG monitoring (ICU EEG) are new and rapidly evolving areas of clinical neurophysiology. Few

practicing neurologists have adequate training in these techniques, and physicians with competence in these

areas are in great demand. Educational activities should cover both basic methodologies for those

practitioners new to ICU EEG and NIOM, and innovative techniques.

Gap #2. General Practice of Clinical Neurophysiology. Clinical neurophysiology procedures are

performed by a large proportion of practicing US neurologists, many of whom have little or no formal

training in clinical neurophysiology. Many clinical neurophysiology procedures (e.g. evoked potentials,

invasive EEG) are performed at low volume at most centers, and a forum for review and hands-on

interpretation are essential to maintain competence in these areas.

Several specific topics with significant gaps between current practice and ideal practice have been identified

via review of the literature, review of clinical neurophysiology fellowship curricula, and surveys of ACNS

members and Annual Meeting attendees.

These include:

Peripheral neurophysiology: Pediatric EMG, critical illness related neurophysiology, and muscle

ultrasound

Basic EEG: Identification of normal variants, identification of artifacts, clinical correlation

Pediatric EEG, especially neonatal EEG

Digital EEG processing, e.g. quantitative EEG and trends for use in the intensive care unit, source

localization, coregistration with neuroimaging, etc.

Full band EEG, Ultrafast and ultraslow EEG

NIOM: Motor evoked potentials, guidelines and standards of care for NIOM (e.g. indications, cost

effectiveness)

Evoked potentials: Current role of short-and long-latency EPs

Video-EEG monitoring, especially invasive EEG

Sleep: Use of new scoring system, implications for patient care

Proposals do not need to be limited to the above topics. We especially welcome programs which have

interactive or hands-on components, and are specifically designed to improve the procedural competence of

attendees.

(Continued on page 7)

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

2013 Annual Meeting and Courses (continued)

Types of Presentations

Symposia should be based on a scientific or clinical theme expanding cutting edge knowledge for a topic

culminating into a conclusion or summary. Symposia should be planned for two hours and no more than

four speakers. Sessions should utilize a lecture style learning format.

Clinical Workshops are forums for clinical discussion and review of difficult clinical issues, within a 90-

minute time slot. These sessions may utilize case discussion, including video and neurophysiologic data,

with a panel of "master" clinicians or utilize semiformal lecture type presentations reviewing clinical topics

that would stimulate discussion. These sessions are most applicable to controversial topics or those in which

there is less definitive data, and will not necessarily reach a conclusion. A question or series of questions

should be introduced to the panel. If case review is selected, the chair is expected to ensure the cases are of

high quality and appropriate data for discussion is available.

Discussion Groups should be considered for topics that avail themselves to active participation of the

audience. This format would encourage active audience participation and be directed toward difficult or

controversial issues in clinical neurophysiology. The discussion group should be planned for a one hour

time slot and contain no more than three discussants. The moderator of the program is expected to ensure

topic discussion and prepare questions that will encourage active participation of the audience.

Financial Disclosures

It is the policy of the ACNS to ensure balance, independence, objectivity, and scientific rigor in all of its

individually sponsored or jointly sponsored educational programs. In order to comply with the ACCME’s

Updated Standards for Commercial Support, the ACNS and the Law requires that anyone who is in a

position to control the content of an educational activity discloses all relevant financial relationships with

any commercial interest pertaining to the content of the presentation. Should it be determined that a conflict

of interest exists as a result of a financial relationship of a planner of the CME activity, the planner must

recuse himself or herself from the planning for that activity or relevant portion of that activity. Should it be

determined that a conflict of interest exists as a result of a financial relationship of a proposed presenter at a

CME activity, the proposed presenter and the CME Committee must agree on a method to resolve the

conflict. Refusal to disclose a conflict or the inability to resolve an identified conflict precludes participation

in the CME activity.

Submitters must sign a Financial Disclosure Form. Submissions are not considered complete and will not be

submitted to the Program Committee unless this signature is on file.

Content Validity

Recommendations involving clinical medicine in a CME activity must be based on evidence that is accepted

within the profession of medicine as adequate justification for their indications and contraindications in the

care of patients. All scientific research referred to, reported or used in CME in support or justification of a

patient care recommendation must conform to the generally accepted standards of experimental design, data

collection and analysis.

The Program Committee will review the proposals and may suggest changes to provide a balance in the

overall program.

REMINDER:

Submission deadline is Monday, January 30, 2012

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

Consortium of Clinical Neurophysiology Program Directors

Submitted by Piotr Olejniczak, M.D.

The CCNPD sent out a survey to clinical neurophysiology program directors with questions about their

experience with last RRC review and about their expectations from CCNPD.

1. Most survey responders (28/31 – 88.7%) were asked by RRC inspectors if the fellows pursued

diplomate exams, but only 4 programs received a citation because of this deficiency.

2. Most responders would prefer to communicate with other program directors through emails sent by the

ACNS office (21/28 – 76%) and/or through an unmoderated listserv (13/28 – 46.4%).

3. Expectations for priority CCNPD services turned out to be very diverse. Suggested ideas included a

bank of PIF proposals, citations and ACGME updates as well as creation of advocacy groups and political/

lobbying action committees. Some responders would prefer more formal meetings at different venues in

contrast to the traditional lunches at the ACNS annual conferences.

The byproduct of this inquiry was an update of the program directors census! Results of current clinical

neurophysiology fellow census are still pending.

Since the results of the survey turned out to be inconclusive for the most important services expected of

CCNPD, we will be asking the program directors what topics re: CCNPD they would like to bring on the

agenda of the upcoming meeting, which will take place on Saturday, February 11th at the ACNS meeting in

San Antonio. I personally strongly support the idea of an “interactive” information bank.

Piotr Olejniczak, M.D., Chair, CCNPD

Case of the Month

Each issue of Clinical Neurophysiology News will feature a clinical case submitted by an ACNS member.

The answer to the case will be available in the Members Only section of the ACNS website (www.acns.org).

This issue’s case is submitted by William O. Tatum IV, D.O. For the answer, sign in to the Members Only

section of the ACNS website: www.acns.org.

Case Study:

A 23-year-old RH WM had drug-resistant epilepsy failing multiple AEDs. He developed normally without

risk factors for epilepsy. Seizure onset began at 7 years of age manifest as “petit mal” seizures that occurred

multiple times during the day. He was begun on ETH with improvement. When “grand mal” seizures

occurred within the year he was changed to valproate yet continued to experience daily brief “petit mal”

seizures. He was sent for evaluation of resective epilepsy surgery when “psychomotor seizures” became

evident at puberty that were resistant to multiple AEDs previously failing trials of VPA, LTG, TPM, LEV,

ZNS, and VNS. He was taking TRL 1200 mg PO BID and LTG 250 mg PO BID at evaluation. His

neurological examination was normal. A high resolution brain MRI with an epilepsy protocol was normal.

Interictal EEG demonstrated classic 3-Hz generalized spike-and-waves without focal features and normal

background.

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

ACMEGS Course in San Antonio

The American Clinical MEG Society will be holding a full-day course on the Principles and Practice of

Clinical Magnetoencephalography on February 8th, 2012 at the ACNS Annual meeting in San Antonio. The

goal of the course is to enhance physicians’ and scientists’ competence and performance in the use of MEG

techniques and interpretation of findings. ACNS designates this live activity for a maximum of 7 AMA PRA

Category 1 Credits™. To learn more, click on the flyer below. The ACMEGS Annual Meeting will be held

on Thursday, February 9th, also in San Antonio. For details, click HERE.

What is the next step?

For the answer and outcome of this case,

Please sign in to the Members Only section of the ACNS website: www.ACNS.org.

If you do not know your username and/or password, please call the ACNS Executive Office at

860-243-3977 or email ACNS@ssmgt.com.

Case of the Month (continued)

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

CPT Code Changes for 2012

Submitted by Marc R. Nuwer, M.D., Ph.D.

ATTENTION: EMG CPT CODE CHANGES!

There are major changes in the way that EMG services are to be coded for CPT in 2012. When NCV and EMG

are performed together, new EMG codes must be used. The purpose is to remove some duplication in payment

that occurred in the traditional coding system.

Starting on January 1, three new codes exist for EMG when done on the same day as NCV testing:

95885 Needle electromyography, each extremity, with related paraspinal areas, when performed, done with

nerve conduction, amplitude and latency/velocity study; limited

95886 complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels

(Do not report 95885, 95886 in conjunction with 95860-95864, 95870, 95905)

95887 Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve con-

duction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)

(Do not report 95887 in conjunction with 95867-95870, 95905)

(Use 95885, 95886, 95887 in conjunction with 95900-95904)

As a first example, the physician performs two motor NCV without F tests, two sensory NCV tests, one limb

EMG testing six muscles, and another limb EMG testing three muscles. The new correct CPT coding will be:

Motor NCV w/o F 95900 2 units

Sensory NCV 95904 2 units

EMG complete 95886 1 unit

EMG limited 95885 1 unit

As a second example, the physician performed a two limb EMG without performing NCV on the same day.

Both limbs included testing 6-7 muscles. Because no NCVs were performed that day on that patient, the old

coding is used. The correct coding remains:

EMG 2 limbs 95861

The EMG section has clarified that EMG equipment produces both audible and visual signals. It includes other

details regarding the new EMG codes. The new header states:

Needle electromyographic (EMG) procedures include the interpretation of electrical waveforms measured by

equipment that produces both visible and audible components of electrical signals recorded from the muscle(s)

studied by the needle electrode. Use 95870 or 95885 when four or fewer muscles are tested in an extremity. Use

95860-95864 or 95886 when five or more muscles are tested in an extremity. Use EMG codes (95860-95864

and 95867-95870) when no nerve conduction studies (95900-95904) are performed on that day. Use 95885,

95886 and 95887 for EMG services when nerve conduction studies (95900-95904) are performed in conjunction

with EMG on the same day. Report either 95885 or 95886 once per extremity. Codes 95885 and 95886 can be

reported together up to a combined total of four units of service per patient when all four extremities are tested.

ATTENTION: SEP AND IOM CPT CODE CHANGES!

Four limb testing of SEP and MEP. Beginning in January 2012, four-limb SEP and MEP tests will be coded as

single codes each. Carriers no longer will accept code pairs 95925 plus 95926, or 95928 plus 95929. The new

codes are:

95938 Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin

sites, recording from the central nervous system; in upper and lower limbs

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

CPT Code Changes for 2012 (continued)

95939 Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs

Use these codes in place of the older pairs of codes when performing four-limb testing, beginning on Janu-

ary 1, 2012. Use these new codes as base codes for intraoperative monitoring when four limbs are moni-

tored.

ATTENTION: SLEEP TEST CPT CODE CHANGES!

A series of Neurodiagnostic CPT code changes will take effect on January 1, 2012. These include New

Definitions for the Sleep Section:

The definitions are useful for certain current sleep test codes. Other words will be useful for future sleep test

codes. The words appear in a header section in the codebook. They do not specifically change the number-

ing or descriptor of a particular code. The definitions are extensive. They are:

Sleep medicine services include procedures that evaluate adult and pediatric patients for a variety of sleep

disorders. Sleep medicine testing services are diagnostic procedures using in-laboratory and portable tech-

nology to assess physiologic data and therapy. All sleep services (95800-95811) include recording, interpre-

tation and report. (Report with modifier 52 if less than 6 hours of recording for 95800, 95801 and 95806-

95811, and if less than four nap opportunities are recorded for 95805).

Definitions

For purposes of CPT reporting of sleep medicine testing services, the following definitions apply:

Actigraphy: the use of a portable, non-invasive, device that continuously records gross motor movement

over an extended period of time. The periods of activity and rest are indirect parameters for estimates of the

periods of wakefulness and sleep of an individual.

Attended: a technologist or qualified health care professional is physically present (ie, sufficient proximity

such that the qualified health care professional can physically respond to emergencies, to other appropriate

patient needs or to technical problems at the bedside) throughout the recording session.

Electrooculogram (EOG): a recording of electrical activity indicative of eye movement.

Maintenance of wakefulness test (MWT): a standardized objective test used to determine a person’s ability

to stay awake. MWT requires sleep staging of the trials that are performed at defined intervals and is at-

tended by a qualified health care professional.

Multiple sleep latency test (MSLT): a standardized objective test of the tendency to fall asleep. MSLT re-

quires sleep staging of the nap opportunities that are performed at defined intervals and is attended by a tech-

nologist or qualified health care professional.

Peripheral arterial tonometry (PAT): a plethysmography technique that continuously measures pulsatile

volume changes in a digit. This reflects the relative change of blood volume as an indirect measure of sym-

pathetic nervous system activity which is used in respiratory analysis.

Physiological measurements of sleep as used in 95805: the parameters measured are a frontal, central and

occipital lead of EEG (3 leads), submental EMG lead and a left and right EOG. These parameters are used

together for staging sleep.

Polysomnography: a sleep test involving the continuous, simultaneous, recording of physiological parame-

ters for a period of at least 6 hours that is performed in a sleep laboratory and attended by a technologist or

qualified health care professional. The parameters measured are a frontal, central and occipital lead of EEG

(3 leads), submental EMG lead and a left and right EOG, (from which sleep is staged), plus four or more

additional parameters. The additional parameters typically required in polysomnography are listed below:

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

CPT Code Changes for 2012 (continued)

A. Electrocardiogram (ECG)

B. Nasal and/or oral airflow

C. Respiratory effort

D. Oxyhemoglobin saturation, SpO2

E. Bilateral anterior tibialis EMG

Positive airway pressure (PAP): a device used to treat sleep-related breath-

ing disorders with the use of noninvasive delivery of positive pressure to the

airway. Examples include but are not limited to: CPAP (continuous posi-

tive airway pressure), bilevel PAP, AutoPAP (autotitrating or adjusting

PAP), ASV (adaptive-servo ventilation).

Remote: the site of service is distant from the monitoring center. Neither a

technologist nor qualified health care professional is physically present at

the testing site.

Respiratory airflow (ventilation): the movement of air during inhaled and

exhaled breaths. This is typically assessed using thermistor and nasal pres-

sure sensors.

Respiratory analysis: generation of derived parameters that describe com-

ponents of respiration obtained by using direct or indirect parameters, e.g.,

by airflow or peripheral arterial tone.

Respiratory effort: contraction of the diaphragmatic and/or intercostal mus-

cles to cause (or attempt to cause) respiratory airflow. This is typically

measured using transducers that estimate motion of the thorax and abdomen

such as respiratory inductive plethysmography, transducers that estimate

pressures generated by breathing muscles such as esophageal monometry,

or by contraction of breathing muscles, such as diaphragmatic/intercostals

EMG.

Respiratory (thoracoabdominal) movement: movement of the chest and

abdomen during respiratory effort.

Sleep latency: the length of time it takes to transition from wakefulness to

sleep. In the sleep laboratory it is the time from “lights out” to the first ep-

och scored as any stage of sleep.

Sleep staging: the delineation of the distinct sleep levels through the simul-

taneous evaluation of physiologic measures including a frontal, central and

occipital lead of EEG (3 leads), submental EMG lead and a left and right

EOG.

Sleep testing (or sleep study): the continuous, simultaneous monitoring of

physiological parameters during sleep (eg, polysomnography, EEG).

Total sleep time: a derived parameter obtained by sleep staging or may be

estimated indirectly using actigraphy or other methods.

Unattended: a technologist or qualified health care professional is not

physically present with the patient during the recording session.

ATTENTION: VNS and DBS CPT CODE CHANGES!

Reprogramming implanted stimulators for DBS and VNS CPT codes have

American Clinical

Neurophysiology Society

Future Meetings

2012 Annual Meeting and

Courses

February 7 - February 12, 2012

Marriott Rivercenter -

San Antonio, Texas

2013 Annual Meeting and

Courses

February 5 - February 10, 2013

Miami Marriott Biscayne Bay -

Miami, Florida

2014 Annual Meeting and

Courses

February 4 - February 9, 2014

Westin Peachtree Plaza - Atlanta,

Georgia

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

CPT Code Changes for 2012 (continued)

minor changes effective January 2012. These codes are “per hour” codes. In cases where the service is half

an hour or less, the short duration needs to be flagged in the coding system using modifier -52. In addition,

the time taken for reprogramming should be documented in the medical records. The specific new CPT

code rule change is given in the final sentence below:

95974 Complex cranial nerve neurostimulator pulse generator/transmitter, with intraoperative or subsequent

programming, with or without nerve interface testing, first hour

95978 Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude

and duration, battery status, electrode selectability and polarity, impedance and patient compliance measure-

ments), complex deep brain neurostimulator pulse generator/transmitter, with initial or subsequent program-

ming; first hour

For 95974 and 95978, use modifier 52 if less than 31 minutes in duration.

Inservice Exam in Clinical Neurophysiology

PLEASE NOTE: REGISTRATION DEADLINE IS JANUARY 20

In February 2012, the American Clinical Neurophysiology Society (ACNS) will offer the 13th annual in-

service examination assessing knowledge of clinical neurophysiology of the central nervous system. The

examination is offered to Clinical Neurophysiology Fellows, Neurology Residents, and also to Attending

Physicians.

The examination will cover basic neurophysiology relevant for the understanding of clinical

neurophysiology tests, technical aspects of physiological recording and testing methodology, and

interpretation of tests with regard to neurological and general medical disease.

Specific topic areas will include:

Basic Neurophysiology

Instrumentation

Clinical EEG

Epilepsy

Clinical Evoked Potentials

Sleep Monitoring

Intraoperative Monitoring

In order to provide residents and program directors with the most useful feedback, scores will be given in

each topic area as well as for the test as a whole. Program Directors will receive all scores and the residents

will receive their individual scores. Percentile scores will be calculated separately for Neurology residents

and Clinical Neurophysiology residents. Attending physicians taking the exam will receive their own

scores.

AC

NS

New

slett

er

Vo

lum

e 4

, Is

sue 1

ACNS Membership

If you are not presently a member of the ACNS, please consider joining. Membership benefits include

reduced fees for CME-accredited meetings and courses, reduced dues for members in training and early

practice physicians, a subscription to the Journal of Clinical Neurophysiology and MORE! For additional

information on ACNS and the benefits of membership, please visit the ACNS website: www.acns.org.

One Regency Drive

P.O. Box 30

Bloomfield, CT 06002

Phone: 860-243-3977

Fax: 860-286-0787

E-mail: ACNS@ssmgt.com

Website: www.ACNS.org

American Clinical Neurophysiology Society

Clinical Neurophysiology training program directors, in particular, will find this examination to be a useful

formal method of trainee assessment.

Trainees will sit the examination locally at their home institutions. It will be a three-hour proctored test of

150 multiple-choice questions, to be given between the dates of Thursday, February 16, 2012, and Monday,

February 20, 2012. Training directors may set the specific time and date of the examination at their sites.

The fee for the examination is $125 per candidate. The registration deadline is January 20, 2012, and

payment must be received by February 1, 2012. Registrations received after the January 20 deadline will be

subject to a $10 per candidate late fee.

To register, return the registration form with the list of all candidates for the exam. If you have any

questions, please contact the ACNS Executive Office at email: ACNS@ssmgt.com or phone: 860-243-3977.

Click here for the Inservice Exam Registration Form.

Inservice Exam in Clinical Neurophysiology (continued)