Blurring of local and remote practice models threatens IOM's future

In this issue of Neurology^®, Nuwer et al.¹ present the results of a recent survey of American Academy of Neurology members concerning practice patterns for intraoperative neurophysiologic monitoring (IOM). The study confirms the continued growth of IOM but also sheds light on striking differences between 2 practice models—“local” monitoring and the “remote” telemetry. For historical reasons, a single Current Procedural Terminology (CPT) code has applied to both models, generating considerable ambiguity and resulting in lack of transparency, particularly to third-party payers, which now presents a serious challenge to the field and to neurologists providing IOM services. On November 1, 2012, with the issuance of the Centers for Medicare & Medicaid Services's (CMS's) Final Rule for Medicaid physician payments,² this challenge became a crisis that threatens to limit IOM services available to Medicare patients.