Small Fiber Neuropathy is often an undiagnosed disease, and the only way to DEFINITIVELY diagnose it is by taking a skin biopsy and performing ENFD testing. Diagnosis can be extremely helpful in determining which treatment option is best for a particular patient. Early detection can also be important since detection of reduced small nerve fiber density can predict the progression to a larger-spread neuropathy. An ENFD test can reduce overall healthcare costs, unnecessary surgeries, unnecessary treatments and improve patient care. Once diagnosed and treated, ENFD testing can be utilized to evaluate that course of treatment for patient improvement, and can be adjusted accordingly if necessary. Standard tests for nerve damage such as electromyograms and nerve conduction studies (EMG and NCS) are gross measures of large nerves, but they cannot give the appropriate information on the health of small sensory nerve fibers.
For a comprehensive assessment, additional stains can be performed on the same specimens being utilized for the ENFD testing.
-Congo-Red-Determines if an amyloid is detected.
-H&E-Can show evidence of Vasculitis.
Performing a Punch Biopsy in your office
In order to obtain a specimen that can be evaluated by Ipsum Diagnostics, a simple 3mm punch biopsy must be taken by a physician or mid-level provider at your practice. This simple procedure is performed under local anesthetic (typically about 1CC of 2% lidocaine with Epinepherine per location) and does not require stitches.
Ipsum Diagnostics can provide the appropriate training to perform this procedure as well as the biopsy kit material (not including the local anesthetic and syringes), paperwork, specimen fixative, and appropriate packaging and shipping material.
When billing for punch biopsies for Epidermal Nerve Fiber Density Testing it is appropriate to bill code 11104 for the first biopsy, and 11105 for each additional biopsy that you perform on the patient. It is billed as a procedure, so be aware that certain insurances may not allow a procedure to be added onto an office visit on that same date (please consult your insurance providers to verify).