Ipsum Diagnostics ENFD Testing

We have partnered with Ipsum Diagnostics to offer Epidermal Nerve Fiber Density (ENFD) testing, which provides an objective diagnosis for patients suffering from small fiber neuropathy. In addition to ENFD testing, we offer Congo Red and H&E testing. Congo Red is performed to identify the presence of amyloids, and H&E detects the presence of Vasculitis, or inflammation of the blood vessels. Both of these conditions can be a causation of small fiber neuropathy. Together, these tests can provide an accurate diagnosis, allowing providers to promptly identify and treat their patient’s small fiber neuropathy.

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In order to utilize this diagnostic test, a provider will perform a 3mm punch biopsy procedure, and ship the sample to Ipsum Diagnostics for testing. The provider has the ability to bill accordingly for performing the biopsy procedure. Ipsum Diagnostics will provide the necessary supplies to perform this simple procedure and send the specimen to our laboratory. With our accurate and prompt results, you can provide the quality of care your patients need.

Why ENFD Testing?

Do you treat patients for Small Fiber Neuropathy? Do you perform EMGs and Nerve Conduction Studies on these patients without conclusive results? Would you like a definitive answer before you proceed with your patient’s treatment process? Epidermal Nerve Fiber Density (ENFD) testing with Ipsum Diagnostics can provide you with the crucial clinical diagnosis youneed in order to appropriately treat your patients with SFN.

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.


Additional Tests

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 a mid-level provider at a practice.  This simple procedure is performed under local anesthetic, should take less than 10 minutes per biopsy, does not require stitches, and can be billed to insurances companies.

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.



Biopsy Billing

When billing the punch biopsy procedure for Epidermal Nerve Fiber Density Testing it is appropriate to bill CPT code 11104 for the first biopsy. Any additional biopsies performed on the same date of service would require the CPT code 11105. You would then utilize a multiplier for the number of biopsies you performed beyond the first. Since it is billed as a procedure, be aware that certain insurances may not allow a procedure to be added onto an office visit on that same date of service (please consult your insurance providers to verify).