Medical Service

Intraoperative Monitoring (IOM)

Intraoperative Monitoring  (IOM)

  • IOM protects patients by continuously monitoring the central nervous system (the brain, spinal cord, and nerves) when it is at risk during surgery.
  • IOM is comprised of various procedures and modalities used during surgery to monitor neural pathways during high-risk neurosurgical, orthopedic, vascular, and peripheral nerve surgeries.
  •  IOM provides the surgeons with information to assist them in preventing damage and preserving functionality of the nervous system
  •  An operating surgeon, an anesthesiologist, a neurophysiologist, and a medical technologist trained by a neurophysiologist-is usually necessary to perform IONM

Cases that may use IOM include:

  • Spinal instrumentation
  • Spinal deformity correction
  • Spinal cord tumors
  • Brain tumors
  • Epilepsy surgical resections
  • Aneurysms
  • Arterial venous malformation (AVM) resections
  • Peripheral nerve interventions

IOM modalities

  • Somatosensory Evoked Potentials (SSEP)
  • Motor Evoked Potentials (MEP)
  • Continuous Electroencephalography (EEG)
  • Auditory Brainstem Response (ABR)
  • Visual Evoked Potentials (VEP)
  • Electromyography (EMG)
  • Language and Motor mapping

Requirement for IOM:

  • To maintain normal patient physiology and homeostasis throughout anesthesia and surgery
  • Blood loss – anemia, hypotension. So it is necessary to recognize when blood transfusion is required for patient.
  • Under general anesthesia patient may be hypo or hyperventilated and may develop hypothermia.
G0453 Continuous intraoperative neurophysiology monitoring, from outside the operating room, per patient, each 15 minutes.
95925 Somatosensory evoked potential; Upper Limbs
95926 Somatosensory evoked potential ;Lower Limbs
95938 Short latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs
95928 Motor Evoked Potential studies performed in upper limb
95929 Motor Evoked Potential studies performed in lower limb
95939 Central motor evoked potential study (transcranial motor stimulation); in upper and lower limbs
95927 Used to report SEP studies of the trunk or head
95861 Needle electromyography
95865 Needle examination of the larynx
95868 Needle examination of 1 or more muscles supplied by cranial nerves on both sides of the body
95864 Record electrical activity that skeletal muscle cells produce while the provider inserts needles into the muscle during rest and while contracted.
95937 Neuromuscular junction testing by repetitive stimulation of a nerve supplying a muscle to diagnose a patient with a known or suspected disorder of the neuromuscular junction.
95955 Electroencephalographic monitoring of a patient during nonintracranial surgery like cardiac surgery or carotid stenting.

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