Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal lev
CPT4 code
Name of the Procedure:
Needle Electromyography (EMG) with Nerve Conduction Studies (NCS), Amplitude and Latency/Velocity Study; Complete Study of Extremities and Related Paraspinal Areas
Summary
Needle Electromyography with Nerve Conduction Studies is a two-part diagnostic procedure used to evaluate the health and function of muscles and the nerves that control them. It involves inserting a needle into specific muscles to record electrical activity and applying small electrical pulses to measure nerve conduction speed and strength.
Purpose
This procedure addresses issues related to muscle and nerve disorders, such as weakness, tingling, numbness, and unexplained pain. The primary goals are to diagnose conditions affecting the peripheral nervous system, such as neuropathies, myopathies, and radiculopathies, and to pinpoint the location and severity of nerve or muscle impairment.
Indications
- Unexplained muscle weakness
- Chronic pain in extremities
- Numbness or tingling sensations
- Suspected nerve compression or injury
- Evaluation of neuromuscular disorders like amyotrophic lateral sclerosis (ALS) or muscular dystrophy
Preparation
- Refrain from applying lotions or oils on the skin prior to the procedure.
- Inform the healthcare provider of any medications or medical conditions.
- May be instructed to fast for a certain period before the procedure.
- Removal of any jewelry or metallic objects that might interfere with the test.
Procedure Description
- The patient is positioned comfortably, typically lying down.
- For the needle EMG, a fine needle electrode is inserted into five or more muscles innervated by different nerves or at least four spinal levels. The needle records the electrical activity during rest and muscle contraction.
- For the nerve conduction study, electrodes are placed on the skin over the muscle or nerve. Small electrical impulses are delivered to measure the speed and strength of the nerve signals.
- Results are recorded and analyzed by the specialist.
Tools: Needle electrodes, surface electrodes, electrical stimulator, EMG machine.
Anesthesia: Generally, no anesthesia is needed. A topical anesthetic may be used to reduce discomfort.
Duration
The entire procedure typically takes about 60 to 90 minutes.
Setting
The procedure is performed in an outpatient clinic, hospital, or specialized diagnostic center.
Personnel
- Neurologist or physiatrist (physician specializing in physical medicine and rehabilitation)
- Trained technician or nurse
Risks and Complications
- Mild discomfort or pain at needle insertion sites
- Bruising or swelling at electrode sites
- Very rare risk of infection
- Potential for temporary increase in symptoms
Benefits
- Accurate diagnosis of nerve and muscle disorders
- Helps in precise localization of nerve or muscle damage
- Accelerates the initiation of appropriate treatment plans
- Enables monitoring of disease progression or response to therapy
Recovery
- Minimal recovery time; most patients resume normal activities immediately.
- Mild soreness or bruising at needle insertion sites, typically resolves in a few days.
- Follow any specific post-procedure instructions given by the healthcare provider.
Alternatives
- Imaging studies like MRI or CT scans
- Blood tests for enzyme levels indicative of muscle damage
- Clinical examination and observation
Pros and Cons: Although imaging and blood tests are less invasive, they may not provide as detailed information about electrical activity and nerve conduction, which are essential for a precise diagnosis.
Patient Experience
During the procedure, patients may experience slight discomfort or mild pain when the needle is inserted or when the electrical pulses are delivered. Post-procedure soreness or bruising is common but usually mild. Patients should communicate any significant pain or discomfort to the healthcare provider promptly. Managing discomfort with over-the-counter pain relievers like acetaminophen can be helpful.