Are Neurotesting devices only for Quacks?

The device had many of the same characteristics that> Dr. Barrett describes under quack electrodiagnostic devices at http://www.quackwatch.org/01QuackeryRelatedTopics/electro.html.>


The most comprehensive and authoritative review of electrodiagnostic testing and procedure coding:
http://www.aanem.org/documents/recpolicy.pdf

Aetna's medical policy:
http://www.aetna.com/cpb/data/CPBA0485.html
(they don't seem to think too highly of these tests)

Local intermediary LCD:
http://www.medicarenhic.com//cal_prov/draft/nervousstudies.htmAn old

Noridian LMRP:
http://www.noridianmedicare.com/provider/pubs/med_a/policy/final/mn/mn99.08a.html

A review article from a professional pain journal. Although this information is somewhat credible, keep in mind this is essentially an opinion from a (looks like) forward-thinking pain treatment practitioner, and shouldn't be necessarily accepted as standard practice, or evidence-based practice, or even accepted practice.
http://www.painphysicianjournal.com/2006/january/2006;9;69-82.pdf

I think if the testing is used and coded as described in the AANEM guideline linked above, it is not fraud in practice, or on a claim. That doesn't mean an insurance carrier won't deny it as not medically necessary/experimental. You have every reason to be skeptical if it looks like this doctor is essentially basing his whole practice on the use of this test or machine - that doesn't sound like good medicine.

The testing is done using an instrument called EDX Epi-Scan

I'm only a little familiar with autonomic function tests. Tests like the QSART mentioned in CPT 95923 have been around a long time, although I had the impression their clinical application and use had shrunk some over the years. And that's probably why most insurers allow them - they haven't been a significant source of utilization or expense. Neurologists use these tests to assess function and develop care plans for people with, for example, Sjogren's Syndrome, diabetic neuropathies, and sometimes spinal cord injuries. Diagnosis of regional pain syndrome is a new one on me. But, given the suspected etiology of this poorly defined condition, I suppose it can make sense.

Like I said, the QSART has been around and is used fairly infrequently in clinical practice within the whole of medicine. The other tests described in the CPT 95923 probable have very little true clinical utility. They might make the clinician nod and scratch a chin, but won't really change the treatment approach one way or another.

So, is it a quack device? Probably not. Is it's use important and essential in the diagnostic work up of regional pain syndrome? Well, it might have it's place. If you have a reputable (board certified) neurologist or rheumatologist doing it for selected patients, and it's not something his/her whole medical practice is based on, I wouldn't be too skeptical.

dras