[baba222]

So...even insurance company says when you present with neuropathic symptoms, large fiber is ruled out, and emgs are negative, a skin punch biopsy is medically necessary.


The assessment of nerve fibers is a component of evaluating peripheral nerve disease. Most nerve disease targets the small nerve fibers (as opposed to large nerve fibers). This document addresses the pathological analysis from skin biopsy specimens of intraepidermal nerve fiber (IENF) density for the diagnosis of small-fiber neuropathy (SFN).

ANTHEM INSURANCE:
Subject: Skin Nerve Fiber Density Testing
Policy #: LAB.00020 Current Effective Date: 07/15/2014
Status: Reviewed Last Review Date: 05/15/2014
Position Statement

Medically Necessary:

Pathological analysis of intraepidermal nerve fiber density for the diagnosis of small-fiber neuropathy is considered medically necessary when all of the following conditions are met:

1. Individual presents with painful sensory neuropathy; AND
2. Physical examination shows no evidence of findings consistent with large-fiber neuropathy, such as reduced or absent muscle-stretch reflexes or reduced proprioception and vibration sensation; AND
3. Electromyography and nerve-conduction studies are normal and show no evidence of large-fiber neuropathy.

Why, oh why can they order expensive tests, but WONT do a biopsy?
Can anyone help me to understand this?

[St George 2013]

My skin punch biopsy was done by a foot and ankle specialist. Neruo's are not the only ones that perform them. Some dermatologists also do them.

I had 2 visits with him when I was trying to figure out what was wrong with me. He mentioned SFN which I had never heard of before. I came home and read about it....called his nurse to see if he could do one and that was that.

Hope this helps.

Debi from Georgia

[janieg]

My neurologist said he didn't feel it was necessary because he was sure SFN was what I had, and a biopsy would do nothing but confirm that. He said it wouldn't be able to help with determining a treatment or anything of that nature.

I see him again in January and will ask if there's any benefit to getting a baseline reading from it.

[baba222]

Originally Posted by janieg

My neurologist said he didn't feel it was necessary because he was sure SFN was what I had, and a biopsy would do nothing but confirm that. He said it wouldn't be able to help with determining a treatment or anything of that nature.

I see him again in January and will ask if there's any benefit to getting a baseline reading from it.

Thanks so much. I do not have a diagnosis and all my tests have come back positive.

[en bloc]

Originally Posted by janieg

My neurologist said he didn't feel it was necessary because he was sure SFN was what I had, and a biopsy would do nothing but confirm that. He said it wouldn't be able to help with determining a treatment or anything of that nature.

I see him again in January and will ask if there's any benefit to getting a baseline reading from it.

There is a definite benefit to having the biopsy. Not only do you get confirmation of the condition and therefore direction to the appropriate treatment (based upon the possible underlining causes), but the test can be repeated in the future to see if the treatment you selected is working or not. It can also help prove to insurance that the treatment is working (especially helpful when using high dollar treatments like IVIG).

[Bowtie]

After my biopsy deemed I had SFN they requested a "sweat gland density test" which my insurance declined as an investigative procedure.

Additionally, the specimen did not yield enough sweat glands to be quantified.


I was unaware the biopsy was going to be sent for additionally testing, but as of now I'm on the hook for it