Close Window
Aetna.com Home    |     Help    |     Contact Us

Search  
Aetna Aetna
Clinical Policy Bulletin:
Surface Scanning and Macro Electromyography
Number: 0112


Policy

  1. Aetna considers surface scanning electromyography (EMG), paraspinal surface EMG, or macro EMG experimental and investigational as a diagnostic test for evaluating low back pain or other thoracolumbar segmental abnormalities such as soft tissue injury, intervertebral disc disease, nerve root irritation and scoliosis, and for all other indications because the reliability and validity of these tests have not been established.

  2. Aetna considers portable surface EMG devices experimental and investigational for diagnosis and/or monitoring of nocturnal  bruxism and all other indications because the reliability and validity of these tests have not been demonstrated.

  3. Aetna considers spinoscopy (Spinoscope, Spinex Corp.), a diagnostic technique that combines surface scanning EMG with video recordings, experimental and investigational as the clinical value of this diagnostic technique has not been validated.

Note: Surface scanning EMG should not be confused with conventional needle EMG, nor with the use of surface electrodes in EMG biofeedback techniques, which are considered medically necessary for appropriate indications.



Background

Surface scanning EMG is different from the conventional needle EMG. Surface scanning EMG employs a scanner with self-contained electrodes and/or surface electrodes that are applied to the skin, and record a specific muscle or group of muscles' electrical potential. There have been attempts to use this technology to diagnose back pain, soft tissue injury, temporomandibular joint dysfunction, nerve root irritation, and scoliosis.

Paraspinal EMG is a type of surface scanning EMG that has been used in evaluation of back pain. The rationale for the use of surface scanning EMG in the evaluation of low back pain appears to be based on the notion that there is a direct relationship between muscular pain and elevated myoelectrical behaviors. However, some investigators have reported no differences in paraspinal EMG levels as a function of pain state in patients with low back pain, and a review of the literature indicates that the relationship between increased EMG activity and the diagnosis/severity of low back pain is still highly controversial.

To date, surface scanning EMG has not been proven to be effective as a diagnostic tool in the evaluation of low back pain and other thoracolumbar segmental abnormalities. The field of scanning EMG is only at the beginning of understanding the characteristics of the surface EMG signal and its relationship to impairment. Further investigation is needed before this technology can be used in a clinical setting.

Surface EMG has also been attempted to diagnose and monitor nocturnal bruxism. Bruxism (the grinding and clenching of teeth) causes abnormal wear of the teeth, sounds associated with bruxism, and jaw muscle discomfort. Portable EMG units are available for use by patients in the home, and involve placement of electrodes on the skin over the muscle being studied (e.g., masseter). Self-monitoring recordings can be imprecise due to recording problems, inconsistent and improper electrode placement, and the collection of muscle activity not associated with occlusal pressure (e.g., oral activity such as yawning and swallowing). An EMG is not required to diagnose bruxism as the consequences of this condition can be observed clinically during a regular dental examination.

Spinoscopy is a testing and analysis procedure that uses a Spinex Spinoscope® System to evaluate the functional status of the back. The Spinoscope is a computer-driven multi-camera video and EMG system that records vertebral movement and the corresponding muscular activity during movements of the back. Spinoscopy has been used to track the coordination of the back and identifies the conditions under which that coordination breaks down. The value of spinoscopy evaluation in diagnosing and monitoring patients with back problems and ultimately improving their outcomes has not been demonstrated in the published peer-reviewed medical literature.

Fuglsang-Frederiksen (2006) evaluated different EMG methods in the diagnosis of myopathy.  These include manual analysis of individual motor unit potentials and multi-motor unit potential analysis sampled at weak effort.  At high effort, turns-amplitude analyses such as the cloud analysis and the peak ratio analysis have a high diagnostic yield.  The EMG can seldom be used to differentiate between different types of myopathy.  In channelopathies and myotonia, exercise testing and cooling of the muscle are helpful.  Macro-EMG, single-fiber EMG and muscle fiber conduction velocity analysis have a limited role in myopathy, but provide information about the changes seen.  Analysis of the firing rate of motor units, power spectrum analysis, as well as multi-channel surface EMG may have diagnostic potential in the future.
 
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes not covered for indications listed in the CPB:
96002
96004
HCPCS codes not covered for indications listed in the CPB:
S3900 Surface electromyography (EMG)
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
306.8 Other specified psychophysiological malfunction
353.0 - 353.9 Nerve root and plexus disorders
355.0 - 355.9 Mononeuritis
722.0 - 722.93 Intervertebral disc disorders
724.00 - 724.9 Other and unspecified disorders of back
728.85 Spasm of muscle
728.9 Unspecified disorder of muscle, ligament, and fascia
729.1 Myalgia and myositis, unspecified
737.30 - 737.39 Kyphoscoliosis and scoliosis
737.43 Scoliosis associated with other conditions
754.2 Certain congenital musculoskeletal anomalies of spine
847.1 Sprains and strains of other and unspecified parts of back, thoracic
847.2 Sprains and strains of other and unspecified parts of back, lumbar
922.31 Contusion of back
959.19 Other injury of other sites of trunk [back]


The above policy is based on the following references:
  1. Waddell G. A new clinical method for the treatment of low-back pain. Spine. 1987;12:632-642.
  2. Glantz RH, Haldeman S. Other diagnostic studies: Electrodiagnosis. In: The Adult Spine. Principles and Practice. Vol. I. JW Frymoyer, ed. New York, NY: Raven Press; 1991; Ch. 26: 541-548.
  3. Arena JG, Sherman RA, Bruno GM, Young TR. Electromyographic recordings of low back pain subjects and non-pain controls in six different positions: Effects of pain levels. Pain. 1991;45(1):23-28.
  4. Arena JG, Bruno GM, Brucks AG, et al. Reliability of an ambulatory electromyographic activity device for musculoskeletal pain disorders. Int J Psychophysiol. 1994:17(2):153-157.
  5. Leach RA, Owens EF Jr, Giesen JM. Correlates of myoelectric asymmetry detected in low back pain patients using hand-held post-style surface electromyography. J Manipulative Physiol Ther. 1993:16(3):140-149.
  6. Triano JJ, et al. The use of instrumentation and laboratory examination procedures by the chiropractor. In: Principles and Practice of Chiropractic. 2nd ed. S Haldeman, ed. Stamford, CT: Appleton & Lange; 1992; Ch. 20: 319-360.
  7. Triano JJ. The subluxation complex: Outcome measure of chiropractic diagnosis and treatment. Chiro Technique. 1990;2:114-120.
  8. Boline PD, Haas M, Meyer JJ, et al. Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality: Part II. J Manipulative Physiol Ther. 1993;16(6):363-374.
  9. Kramer MS, Feinstein AR. Clinical Pharmacol Ther. 1981;29(1):111-123.
  10. Meyer JJ. The validity of thoracolumbar paraspinal scanning EMG as a diagnostic test: An examination of the current literature. J Manipulative Physiol Ther. 1994;17:539-551.
  11. McMaster University Health Science Center, Department of Clinical Epidemiology and Biostatistics. How to read clinical journals: II: To learn about a diagnostic test. Can Med Assoc J. 1981;124:703-710.
  12. Ng JK, Richardson CA. Reliability of electromyographic power spectral analysis of back muscle endurance in healthy subjects. Arch Phys Med Rehabil. 1996;77(3):259-264.
  13. Longstreth WT Jr, Koepsell TD, van Belle G. Clinical neuroepidemiology I: Diagnosis. Arch Neurol. 1987;44(10):1091-1099.
  14. Myerowitz M. Scanning paraspinal surface EMG: A method for corroborating post-treatment spinal and related neuromusculoskeletal symptom improvement. J Occup Rehabil. 1994;4(3):171-179.
  15. Greenough GC, Oliver CW, Jones AP. Assessment of spinal musculature using surface electromyographic spectral color mapping. Spine. 1998;23(16):1768-1774.
  16. Oddsson LI, Giphart JE, Buijs RJ, et al. Development of new protocols and analysis procedures for the assessment of LBP by surface EMG techniques. J Rehabil Res Dev. 1997;34(4):415-426.
  17. Kollmitzer J, Ebenbichler GR, Kopf A. Reliability of surface electromyographic measurements. Clin Neurophysiol. 1999;110(4):725-734.
  18. Wolf LB, Segal RL, Wolf SL, et al. Quantitative analysis of surface and percutaneous electromyographic activity in lumbar erector spinae of normal young women. Spine. 1991;16(2):155-161.
  19. Moritani T, Yoshitake Y. 1998 ISEK Congress Keynote Lecture: The use of electromyography in applied physiology. International Society of Electrophysiology and Kinesiology. J Electromyogr Kinesiol. 1998;8(6):363-381.
  20. Roy SH, Oddsson LI. Classification of paraspinal muscle impairments by surface electromyography. Phys Ther. 1998;78(8):838-851.
  21. Roy SH, De Luca CJ, Casavant DA. Lumbar muscle fatigue and chronic lower back pain. Spine. 1989;14(9):992-1001.
  22. Roy SH, De Luca CJ, Emley M, et al. Classification of back muscle impairment based on the surface electromyographic signal. J Rehabil Res Dev. 1997;34(4):405-414.
  23. De Luca CJ. Use of the surface EMG signal for performance evaluation of back muscles. Muscle Nerve. 1993;16(2):210-216.
  24. Airaksinen O, Airaksinen K. Ambulatory device for surface EMG recordings. Acupunct Electrother Res. 1998;23(1):9-17.
  25. Sihvonen T, Partanen J, Hanninen O, et al. Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls. Arch Phys Med Rehabil. 1991;72(13):1080-1087.
  26. Jalovaara P, Niinimaki T, Vanharanta H. Pocket-size, portable surface EMG device in the differentiation of low back pain patients. Eur Spine J. 1995;4(4):210-212.
  27. Roy SH, De Luca CJ, Emley M, et al. Spectral electromyographic assessment of back muscles in patients with low back pain undergoing rehabilitation. Spine. 1995;20(1):38-48.
  28. Lee DJ, Stokes MJ, Taylor RJ, et al. Electro and acoustic myography for noninvasive assessment of lumbar paraspinal muscle function. Eur J Appl Physiol. 1992;64(3):199-203.
  29. Traue HC, Kessler M, Cram JR. Surface EMG topography and pain distribution in pre-chronic back pain patients. Int J Psychosom. 1992;39(1-4):18-27.
  30. Cram JR, Steger JC. EMG scanning in the diagnosis of chronic pain. Biofeedback Self Regul. 1983;8(2):229-241.
  31. Krivickas LS, Taylor A, Maniar RM, et al. Is spectral analysis of the surface electromyographic signal a clinically useful tool for evaluation of skeletal muscle fatigue? J Clin Neurophysiol. 1998;15(2):138-145.
  32. Sparto PH, Parnianpour M, Reinsel TE, et al. Spectral and temporal responses of trunk extensor electromyography to an isometric endurance test. Spine. 1997;22(4):418-426.
  33. Kankaanpaa M, Taimela S, Laaksonen D, et al. Back and hip extensor fatigability in chronic low back pain patients and controls. Arch Phys Med Rehabil. 1998;79(4):412-417.
  34. Kankaanpaa M, Taimela S, Webber CL Jr, et al. Lumbar paraspinal muscle fatigability in repetitive isoinertial loading: EMG spectral indices, Borg scale and endurance time. Eur J Appl Physiol. 1997:76(3):236-242.
  35. Academy of General Dentistry (AGD). Bruxism (tooth grinding). AGD Consumer Information. Chicago, IL: AGD; 2001. Available at: http://www.agd.org/consumer/topics/bruxism.html. Accessed July 12, 2001.
  36. Hudzinski LG, Walters PJ. Use of a portable electromyogram integrator and biofeedback unit in the treatment of chronic nocturnal bruxism. J Prosthet Dent. 1987;58(6):698-701.
  37. Hemingway MA, Biedermann HJ, Inglis J. Electromyographic recordings of paraspinal muscles: Variations related to subcutaneous tissue thickness. Biofeedback Self Regul. 1995;20(1):39-49.
  38. Cengiz B, Ozdag F, Ulas UH, et al. Discriminant analysis of various concentric needle EMG and macro-EMG parameters in detecting myopathic abnormality. Clin Neurophysiol. 2002;113(9):1423-1428.
  39. Hogrel JY. Clinical applications of surface electromyography in neuromuscular disorders. Neurophysiol Clin. 2005;35(2-3):59-71.
  40. Geisser ME, Ranavaya M, Haig AJ, et al. A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. J Pain. 2005;6(11):711-726.
  41. Fuglsang-Frederiksen A. The role of different EMG methods in evaluating myopathy. Clin Neurophysiol. 2006;117(6):1173-1189.


email this page   


Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
Aetna
Back to top