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What is "ENFD" testing?
The Epidural Nerve Fiber Density (ENFD) Test is the only definitive method for diagnosing Small Fiber Neuropathy (SBN). By performing a skin biopsy of the peripheral nerves within the epidermis, studies have shown high sensitivity (88%) and specificity (98%). ENFD testing is recommended for those with pain & abnormal sensations, or those with high comorbidity rates that could present asystematic.
Who to test?
Patients suffering from pre-diabetes, diabetes, fibromyalgia, auto-immune disorders, or other metabolic syndromes should be tested. Additionally, patients can be tested if dealing with pain, numbness or tingling, abnormalities in blood pressure, or loss of coordination or balance qualify for this test.
Skin Biopsy Procedure?
Test ENFD test kit is at no cost to the physician and;
**See link to Nova Dx ENFD Procedure Overview (2 pages)
Reports will be available via a portal 10-14 business days following the procedure Include link to ENFD reports to length/non-length
There are many options available for treating Small Fiber Neuropathy. The most effective ones address the underlying cause. Most often, the focus of treatment is on symptom control. If the cause is diabetes, pre- diabetes, or metabolic syndrome, papers have shown the symptoms improve by treating the insulin resistance, deconditioning and vitamin deficiencies. Literature suggests that patients can be helped by physical therapy, well balanced diets, avoiding exposure to toxins, exercise, vitamin supplements, limiting or avoiding alcohol, prescription drugs or other complementary and integrative therapy
Small Fiber Neuropathy (SFN) is a disorder affecting the small sensory cutaneous nerves; also known as peripheral/sensory neuropathy. These nerve fibers innervate the skin and influence temperature, nociception, and autonomic regulation. The majority of patients exhibit symptoms that work distal to proximal, usually starting in the feet.
Epidural Nerve Fiber Density Testing though Nova Dx categorizes small fiber neuropathy into two sub-types:
Knowing the proper sub-type allows for proper physician innervation & treatment
Maybe list: PT, cut out alcohol/drugs, vitamins, change in diet, avoid exposure to toxins (metals chemo)
About Nova Dx
Nova Dx is a State-Of-The-Art diagnostic pathology service. Quality laboratory service for today’s clinician, with both CLIA & CAP accreditations.
Been around for since 2010
Not really any info?
Why Is ENFD Testing The Gold Standard?
ENFD testing is the only way to definitively diagnose SFN. Whereas EMG and NCS tests only test for large fiber neuropathy & monofilament is subjective to each clinician.
Electromyography (EMG) measures nerve conduction via a needle in a specific muscle. The number of muscles tested is highly variable to the number of symptoms. This process can be painful in a high number of patients. The results for this procedure are in Motor Unit Potentials (MUPs) which is for large fiber neuropathy.
Nerve Conduction Study (NCS) measures how fast an electrical impulse travels through the nerve via two electrodes. One electrode sends an impulse while the other waits to record the time and converts it to conduction speed. The results for this procedure are in Meters/Second (m/s) which is for large fiber neuropathy. Monofilament Testing is an in-expensive, easy-to-use test for peripheral neuropathy. A patient is placed in a manner that they cannot see the tested site (usually supine). The clinician then uses a monofilament (soft brush) to go over various locations to test sensitivity of touch. The results for this procedure are in non-sensitive locations, thus more non-sensitive locations the higher risk of neuropathy.
NovaDx is contracted with all federal & commercial insurances
CPT Billing Codes
11104 → Punch Biopsy Single Lesion
11105 → Punch Biopsy Each Additional Lesion (up to 3)
99213 → Office/Outpatient Visit
88305 → Tissue Examination By Pathologist (only for pathology lab & prior auth)
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