Continuous Intraoperative Neurophysiology Monitoring (G0453)

Name of the Procedure:

• Common Name: Remote Intraoperative Neurophysiology Monitoring
• Technical Term: Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)

Summary

Intraoperative neurophysiology monitoring involves continuous observation and assessment of the nervous system while a patient is undergoing surgery. This specific procedure (G0453) is conducted remotely, meaning the monitoring specialist is not physically present in the operating room but remains focused on the patient’s neural functions throughout the surgery.

Purpose

This procedure aims to identify and prevent neurological complications in real-time during surgeries that pose risks to the nervous system. By continuously monitoring neural activity, the medical team can make immediate adjustments to avoid permanent nerve damage.

Indications

• Spinal surgeries that risk impinging nerve roots
• Brain surgeries near critical neural structures
• Orthopedic procedures involving the spine
• Cardiovascular surgeries requiring extended anesthesia

Preparation

• No specific patient preparations are needed for this procedure as it complements the primary surgery.
• Pre-operative assessments and imaging studies (MRI, CT scans) may be reviewed to identify areas of concern.

Procedure Description

1. Neurophysiological data (e.g., EEG, EMG, SSEP) is continuously recorded using sensors attached to the patient's body.
2. The neurophysiologist monitors these signals remotely.
3. Any significant changes in neural activity are communicated to the surgical team in real-time.
4. Adjustments are made to anesthesia levels, surgical technique, or patient positioning based on the neurophysiologist’s observations.

• Tools: Electrodes, amplifiers, monitoring software
• No anesthesia or sedation adjustments specific to this monitoring; covered as part of the primary procedure.

Duration

The monitoring is continuous and ongoing, matching the duration of the primary surgical procedure. Billing is done in 15-minute increments.

Setting

• Performed remotely from a location near or away from the operating room, potentially from a monitoring facility or workstation within the hospital.

Personnel

• Neurophysiologist: Specializes in neurophysiology monitoring
• Surgeons, anesthesiologists, and operating room nurses performing the primary surgical procedure

Risks and Complications

• No direct risk to the patient from the monitoring itself.
• Possible temporary skin irritation from electrode placement.
• Rare risk of misinterpretation of neurophysiological data.

Benefits

• Reduced risk of postoperative neurological deficits.
• Early detection of issues allowing for immediate corrective action.
• Potentially improved surgical outcomes and faster recovery.

Recovery

• No specific recovery needed from the monitoring aspect itself.
• Recovery instructions pertain to the primary surgical procedure and will be provided by the attending surgical team.

Alternatives

• No direct alternatives to continuous remote monitoring if intraoperative neurophysiology monitoring is indicated.
• Procedures may proceed without neurophysiological monitoring, carrying a higher risk of undetected nerve damage.

Patient Experience

• The patient will not be aware of the monitoring; it is non-invasive and occurs while the patient is under general anesthesia for the primary surgery.
• Postoperative pain and discomfort will be managed by the surgical team, with no additional discomfort from the monitoring process itself.