Surgery can be unpredictable and potentially dangerous especially when it involves areas near the brain, spinal cord, or nerves. Intraoperative monitoring (IOM) allows for the nervous system to be monitored in real-time and is proven to make surgeries safer.

At NW Monitoring we are focused on the pursuit of excellence in clinical outcomes and customer service. Our IOM technologist is part of your surgical team and helps to assess the health of your nervous system throughout the procedure. They identify developing neurological issues and communicate potential complications to your surgeon.  This allows for corrections to be implemented promptly to avoid or mitigate long-term neurological deficit.

If you have questions about IOM and how it can help protect your nervous system’s function, please see our FAQ’s section.

intraoperative neurophysiologist technician running testing during spine surgery

You've Got Questions? We've Got Answers

For more information you can view our FAQs below or call us at (360) 742-3538.
What is IOM?

Intraoperative Monitoring (IOM) provides your surgeon with real-time feedback on the function and health of your nervous system throughout your surgical procedure. The use of IOM mitigates some of the risks inherent to surgeries involving the spinal cord and nerves by alerting your surgical team to potential injuries before they cause post-surgical deficits.

Who performs IOM?

Our IOM technologist will be an integral part of your surgical team and will be in the room with you throughout your surgery.  After anesthesia has taken effect, our technologist will attach a series of electrodes at different points on your body depending on the type of surgery being performed and the areas at risk.  Once the electrodes are in place they are connected to specialized monitoring equipment which is used to run tests on your neurological function.

Using sophisticated and secure telemedicine services, your neural responses will be monitored onsite by our technologist and remotely by one of NW Monitoring’s supervising neurologists . If changes occur during the procedure our technologist will alert your surgeon who will take immediate action.

What tests are run during IOM?

The Electroencephalogram (EEG)
This test is a recording of the brain’s on-going electrical activity. EEG assists in the diagnosis of various brain disorders and assures the surgeon that the brain is receiving enough oxygen.

The Somatosensory Evoked Potential (SSEP)
This test measures the transmission of sensation above and below the area of surgery. Electrodes are stimulated with an electrical current at the hands and feet and the response is recorded as the signal travels to the brain. This process checks the function of the sensory portion of the nerves and spinal cord.

The Motor Evoked Potential (MEP)
The MEP test involves the electrical stimulation of the motor cortex using electrodes on the scalp. This stimulation illicits a motor response causing movement of the extremities. This process checks the function of the motor portion of the nerves and spinal cord.

Electromyography (EMG)
This test evaluates electrical potentials from spinal nerve roots and peripheral nerves. Electrodes are placed into the muscles that are controlled by the nerves at risk and monitored for activity which helps the surgeon ensure the nerves are not damaged during certain surgical procedures.

Pedicle Screw Testing
These tests assist surgeons during the placement of hardware in spine surgeries. Surgeons place a probe over the pedicle screw which delivers a small electrical current and verifies that no breach or crack in the bone occurred during screw placement.

Brainstem Auditory Evoked Responses (BAER, BAEP, BEP)

Brainstem evoked potentials are obtained by stimulating the auditory system using click stimuli. These clicks illicit neural action potentials and are used to evaluate disturbances of the auditory nerve along with retractor disturbances of the brainstem.

What education and training do our IOM technologists have?

Your safety is our number one priority which is why all of our IOM technologists are board certified or eligible to obtain The Certificate in Neurophysiologic Intraoperative Monitoring (CNIM®). The CNIM® is awarded by the American Board of Electroencephalographic and Evoked Potential Technologists (ABRET®) and is recognized as the standard for IOM technologists. Our protocols and procedures are also written according to the technical and clinical standards set by ABRET®. With NW Monitoring you can rest assured that you are being attended by  highly trained and experienced technologists. 

For further information please go to the American Board of Electroencephalographic and Evoked Potential Technologists Website:

Why is my surgeon using IOM?

Many complications involving the nervous system can be avoided with careful monitoring during surgery. Your surgeon recognizes the advantage of IOM as another tool in addition to his or her own surgical skill along with its proven benefit to improve the outcomes of surgery.

Is IOM covered by my insurance?

While the hospital and your surgeon are in network, we are considered an out of network provider as currently required by health insurance companies. Our services have been billed to your insurance provider separately from the hospital’s and surgeon’s fees.

Will I receive a bill for the services provided?

We have developed a process for working with your insurance company to ensure  the costs for the service you received from your in-network surgeon are covered. This process may take several months and you may receive an Explanation of Benefits (EOB) as we communicate back and forth with your insurance company. Please be assured THIS IS NOT A BILL. We go to great lengths to continue to care for your well-being after your surgery and part of that care is ensuring you are no exposed to any undue stress.

If you receive a payment from your insurance provider following your surgery, please contact our office immediately at (360) 539-8487. This payment is for NW Monitoring for the services we provided during your procedure.

Will I be responsible for costs not covered by insurance?

Any co-pay or co-insurance that is not covered may be billed to you, however we work directly with your insurance provider to minimize and/or eliminate any out-of-pocket costs.

My EOB states an amount under patient responsibility. Is this really my responsibility?

No, we will negotiate throughout the entire process and utilize all means available to reduce costs to you.

Are there any payment plans available to me?

We have interest-free payment plans and financial hardship waivers available if necessary.

Do I contact my surgeon for insurance/billing questions?

No. We understand that you may have questions about your claim as it goes through this process. You are encouraged to contact our billing representatives at 360-539-8487 or

Let Us Know How We Can Help You!