Autonomic Function Testing Content Gathered from CMS National Coverage Policy Indications And Medical Necessity

Autonomic Function Testing The Autonomic nervous system (ANS) regulates physiologic processes, such as blood pressure, heart rate, body temperature, digestion, metabolism, fluid and electrolyte balance, sweating, urination, defecation, sexual response, and other processes.

Autonomic Funtion Testing The aim of Autonomic Function Testing is to correlate signs and symptoms of possible autonomic dysfunction (Disautonomia) with objective measurement in a way that is clinically useful. Many organs are controlled primarily by either the sympathetic or parasympathetic system, although they may receive input from both; occasionally, functions are reciprocal (e.g.,sympathetic input increases heart rate parasympathetic decreases it).

Autonomic Function Testing Symptoms suggesting autonomic dysfunction include orthostatic hypotension, heat intolerance, nausea, constipation, urinary retention or incontinence,nocturia,impotence, and dry mucous membranes. If a patient has symptoms suggesting autonomic dysfunction, cardiovagal, adrenergic, and sudomotor tests are usually done to help determine severity and distribution of the dysfunction.

Autonomic Function Testing Our ANS testing can be grouped into three general catagories. 1. Cardiovagal innervation- a test that provides a standardized quantitative evaluation of vagal innervation to parasympathetic function of the heart. Responses are based on the interpretation of changes in continuous heart recordings in response to standardized maneuvers and inc heart rate response to deep breathing., Valsalva ration, and 30:15 ratio heart rate responses to standing.

Autonomic Function Testing Sudomotor-function testing is used to evaluate and document neuropathic disturbances that may be associated with pain. The quantitative sudomotor axon reflex (QSART). Thermorgulatory sweat test (TST) sympathetic skin responses, and slastic sweat imprints are tests sympathetic cholinergic sudomotor function.

Indications Tests are useful in defining the presence of autonomic failure, their natural history, and response to treatment. The can also define patterns of dysautonomia that are useful in helping the clinician diagnose certain autonomic conditions. Selective autonomic failure (which only one system is affected) can be diagnosed by AUTONOMIC FUNCTION TESTING.

Indications 1. To diagnose the presence of autonomic neuropathy in a patient with signs or symptoms suggesting a progressive autonomic neuropathy. 2. To evaluate the severity and distribution of a diagnosed of a diagnosed progressive autonomic neuropathy. 3. To differentiate the diagnosis between certain complicated variants of syncope from other causes of loss of consciousness. 4. To evaluate inadequate response to beta blockade in vasodepressor syncope. 5. T evaluate distressing symptoms in a patient with a clinical picture suspicious for distal small fiber neuropathy in order to diagnose the condition.

Indications 6. To differentiate the cause of tachycardia syndrome. 7. To evaluate change in type, distribution or severity of autonomic deficits in patients with autonomic failure. 8. To evaluate the response to treatment in patients with autonomic failure who demonstrate a change in clinical exam. To diagnose axonal neuropathy or suspected autonomic neuropathy in symptomatic patients. To evaluate and treat patients with recurrent unexplained syncope or demonstrate autonomic failure, after more common causes have been excluded by other standard testing.

Shores Diagnostic Testing Protocol 1. Cardiovagal innervation 2. QSART 3. Peripheral Artial Disease (ABI) Ankle Brachial Indice and (TBI) Toe Brachial Indice. Its impact as a potential comorbidity to peripheral neuropathy and as a highly sensitive marker for Peripheral Arterial Disease (PAD) as well as a well documented marker for CAD. 4. BMI