EMG Tests (California)

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EMG Tests (California)

Postby injured7825 on Mon Sep 08, 2014 11:20 pm

I have a question about EMG tests, I have been diagnosed a couple of years ago with radiculopathy at L5/S1 level bilaterally, well according to the guidelines per the treatment request denial that they are medically necessary only to obtain unequivocal evidence of radiculopathy, my question is this, while there is evidence of radiculopathy at levels L5/S1, would it not be medically necessary to know if there is radiculopathy or nerve damage at higher levels of the spine due to further deterioration and increase of pain at higher levels?
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Re: EMG Tests (California)

Postby LawAdvocate on Tue Sep 09, 2014 7:57 am

That should be well documented by an MRI which shows encroachment on a nerve structure. So if you have radiculopathy it does not matter what level it is emanating from except for as to what body parts the radiculopathy effects. If the deterioration is still in your low back, you will have lower limb radiculopathy.
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Re: EMG Tests (California)

Postby chirple on Tue Sep 09, 2014 9:48 pm

There are two good reasons for EMG to determine radiculopathy.

1) for assessment of PD, where radiculopathy is required for certain PD calculations that require radiculopathy at multiple levels.

2) pre-surgical to determine if a bulge or herniation that shows on MRI is, in fact, responsible for radiculopathy and may be surgical.

Bulge on MRI is not evidence of radiculopathy, w/out concurrent and matching symptoms. EMG confirms the level of bulge/herniation is the source of the symptom and points toward treatment options.
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Re: EMG Tests (California)

Postby chirple on Tue Sep 09, 2014 9:48 pm

There are two good reasons for EMG to determine radiculopathy.

1) for assessment of PD, where radiculopathy is required for certain PD calculations that require radiculopathy at multiple levels.

2) pre-surgical to determine if a bulge or herniation that shows on MRI is, in fact, responsible for radiculopathy and may be surgical.

Bulge on MRI is not evidence of radiculopathy, w/out concurrent and matching symptoms. EMG confirms the level of bulge/herniation is the source of the symptom and points toward treatment options.
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Re: EMG Tests (California)

Postby injured7825 on Thu Sep 11, 2014 6:53 am

Thanks, chirple, this EMG is for pre surgical, there was also a major discrepancy with the receive date for the request, the fax confirmation date for the treatment request is 5 days earlier then what is stated in the UR denial, all I need to do is to get my attorney to act on that.
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Re: EMG Tests (California)

Postby chirple on Sun Sep 21, 2014 10:38 am

YOU can do an IMR appeal of that UR Denial, if it is within the allowable time frame.

Review the UR denial paperwork and it will tell you how. Make sure your doctor and your attorney know you are doing this, so that we do not burden the Maximus vendor with unnecessary duplicates requests. They are far enough behind.
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Re: EMG Tests (California)

Postby injured7825 on Sun Sep 21, 2014 5:43 pm

Oh I did file with IMR already, if I'm lucky I will hear back by Christmas.
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