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.
| CPT | DESCRIPTION |
| 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. |