Frequently Asked Questions

Intraoperative Neurophysiological Monitoring (IONM) or Intraoperative Monitoring is a technique that is used to reduce the risk of neurological injuries or damage to a patient during surgery which may not be evident until after an operation. IONM records electrical responses from sensors placed on the patient's body and monitors the functional integrity of the body's neural network. The information provided by IONM allows a surgeon to perform a safer and more controlled surgery for the patient.

A minimum of two of our staff members work together to perform the Intraoperative Monitoring. The first staff member is a Neurotechnologist who is with the patient in the operating room, and the other member is a physician who reviews the data via real time over the Internet.

The following tests are conducted with Intraoperative Monitoring.

Somatosensory Evoked Potentials (SSEPs)

An electrical signal created by applying stimulus to the nerves in the extremities and recorded by using electrodes placed on the scalp in order to ensure no changes occur to the posterior spinal column during surgery.

Transcranial Motor Evoked Potentials (TcMEPs)

Monitors the anterior function of the spinal cord during surgery by introducing stimulus on the scalp and recording muscle responses in the extremities that correlate to the levels of the spine being operated on.

Electromyography (EMG)

Records muscle activity related to external stimulus to nerves and nerve roots during surgery to identify potential risks to nerves and help prevent permanent damage.

Pedicle Screw Testing

When screws are inserted into vertebrae during spine surgery, a probe is used to add direct stimulus to the screws to ensure no damage is done to the pedicle, helping prevent nerve irritation or nerve root impingement.

Electroencephalogram (EEG)

Monitors the integrity of the brain by using multiple electrodes placed at specific locations on the scalp that can detect blood flow to the brain and levels of brain activity.

Brainstem Auditory Evoked Potentials (BAEPs)

A response recorded from using an auditory stimulus sent through the ear canal that records brainstem function as well as ensures the auditory nerve does not become damaged during surgical manipulation.

Nerve Conduction Study

Used to determine whether a neural pathway is intact and operating correctly. An electrical impulse is applied to the nerve and the response is recorded from a correlating muscle.

Your well-informed surgeon wants the most advanced, state-of-the-art technology to assist him/her in achieving the best outcome for your procedure by utilizing real time testing of nerve functions.

Our technologist will take a brief history before you go into the operating room and answer any questions you may have. The technologist will then place a series of sticky electrodes at several points along your nerve pathway, and additional electrodes will be attached in the operating room when you are asleep. All of these electrodes will collect data during the surgery which is sent to our physician off-site to review and analyze. For any issue that may arise, our technologist and physician can communicate instantly to the surgeon.

Our clinical guidelines are among the highest level in the industry. Each technologist is board certified in CNIM or R.EPT from ABRET. In addition, each technologist has broad experience in the healthcare industry. You can read about our other accreditations here.

Having a technologist in the operating room allows the surgeon to focus all of his attention on the surgery and not reading data and reports.

AXIS Neuromonitoring provides remote physician supervision as an integral part of its service. It's like having another doctor in the operating room. This physician is interpreting the data from the technologist in real time. This is very important since many medical conditions can affect the quality of the results (i.e., types of anesthesia, medications and patient health history).

Our services are covered by most insurance plans. Of course, each insurance policy is unique to each patient. You should always check with your insurance company for more information. AXIS does provide services regardless of a patient's personal ability to pay. All of our billing department experts are pursuant in or have obtained their certificates including Certified Medical Coder from the Practice Management Institute, Certified Medical Reimbursement Specialist from the American Medical Billing Association, and Certified Billing and Coding Specialist from the National HealthCareer Association.

We strive to verify your coverage, help you understand your coverage, and put your plan to work for you. If you have any questions or concerns, please feel free to contact our helpful billing specialists.

If your surgeon requested IONM out of medical necessity, contact the AXIS Patient Care Advocate Team so we can verify your benefits before surgery. Our Pre-Certification team will then work with your insurance company to get IONM covered. Provide us with all relevant financial information (especially if you have financial hardships) and we can help with applicable discounts for self pay and commercial insurance. Read more about getting IONM covered by insurance.