AFTER 50 YEARS, EMG REMAINS AN ABUSED DIAGNOSTIC TEST
Kudos to the authors of a study published in Neurology, January 19, 2016, with lead author Narayanaswami, who tried to establish sensitivity and specificity of needle EMG for diagnosis of radiculopathy. Both were over 70%. Keep in mind, however, that this was done by experienced electromyographers in an academic setting. These results do not automatically translate for neurologists or physiatrists in “community” practice. Many are well trained, experienced, and perform high-quality, ethical, and cost-efficient studies. A significant number, however, do not, and there is great abuse, especially in the workers’ compensation setting.
An editorialist in the journal Muscle & Nerve many years ago bemoaned the fact that an EMG report was considered the “WOG” (Word of God). I estimate I have performed 15,000 EMGs in my career. I recall, as a consultant for Medicare, viewing a video of a neurologist who billed four extremities as well as cervical spine, thoracic spine, lumbar spine, each as an extremity; and every possible motor and sensory nerve and F-wave in all patients, irrespective of diagnosis. Incredibly, he claimed he could do all this in 30 minutes. It would have been comical if it were not outrageous to watch him run around the exam table sticking needles in at random and stimulating nerves at supramaximal intensity each time.
If only the medical community and regulatory authorities targeted abuse and made consistent efforts to improve the quality and cost-effectiveness of EMG. The Medicare administration threw up its hands in doing meaningful reform and instead reduced reimbursement by about 50%. This has led to reduced quantity but certainly not to increased quality.
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