Industry Statements

“Journal of Clinical Neurophysiology” 11 (1):77-87, 1994
American Electroencephalographic Society

“Guideline Eleven: Guidelines for Intraoperative Monitoring of Sensory Evoked Potentials”

“I. Recommended standards for Intraoperative Monitoring of Sensory Evoked Potentials”

…”Intraoperative monitoring requires a team approach with the cooperation among the surgical team, the anesthesiologist, and the monitoring team. The surgeon should be knowledgeable in the methodology of EP monitoring, since he will be participating in solving problems related to stimulating and recording electrodes.

Interpretation of changes will always relate to pharmacologic, physiologic, and mechanical factors under the control of the surgeon and anesthesiologist. The anesthesiologist has a key role in the selection of the appropriate anesthesia to insure maximal patient safety with minimal influence on the monitoring of EPs. The monitoring team must be familiar with intraoperative recording and must immediately notify the surgical team and the anesthesiologist of any change in the EPS under study. The monitoring team must be able to solve the technical difficulties related to intraoperative monitoring.

The monitoring team should be under the direct supervision of a trained clinical neurophysiologist (M.D., Ph.D., or D.O.) experienced in EPs.”

American Society of Electroneurodiagnostic Technologists
“ASET Position Statement on Electroneurodiagnostic Technologists in the Operating Room” 1998 **accepted by the American Association of Neurology

…“The qualified END technologist may furnish the surgeon a description of the waveforms being recorded, provided the surgeon has received sufficient END education to interpret the technologist’s waveform descriptions. It is the responsibility of the technologist to document in the patient’s chart the waveform description given to the surgeon.

Responsibilities
Interpretation of the intraoperative recording, recommendations, and decisions regarding action or consequence are the responsibility of a qualified physician or clinical neurophysiologist (M.D., D.O., Ph.D.). It is recommended that an interpreting physician/neurophysiologist be physically present or present by means of a real-time, remote mechanism for all END monitoring situations. When electrical activity is recorded directly from the surface of the brain, a physician neurophysiologist must be physically present or present by means of real-time, remote mechanism to interpret the recording and to advise the surgeon. For other types of monitoring when the physician/neurophysiologist is not present physically or by means of remote mechanism and when the technologist is providing the waveform description, the surgeon or anesthesiologist is responsible for the interpretation, diagnosis, and course of action; with the medical director of the electroneurodiagnostic department or a physician neurophysiologist bearing the responsibility for educating the surgeon regarding possible interpretations and potential consequences of the waveforms identified by the technologist.”

Medicare Report on Intraoperative Neurophysiology Testing

“The physician billing the service must be performing the service in real-time and solely dedicated to performing this service. The physician may be in the operating room suite or at a remote site with the monitoring performed utilizing digital transmission or closed circuit television. Additionally, when digital transmission or closed circuit television is utilized, there must be a provision for continuous or immediate contact with the operating surgeon to ensure any changes in the patient’s status can be immediately communicated”

Medicare Report/December 1999, Health Care Financing Administration, New Policy on Intraoperative Neurophysiology Testing. (M-55)