# nerve monitoring



## AnneCline (Oct 29, 2009)

Would anyone be able to help with this one?  I have an example to show.  I am getting totally confused with the nerve monitoring cases!  What CPTs would I use?  95920?  But with what else?

Rt thyroid lobectomy and isthmusectomy with 2 hours recurrent laryngeal nerve monitoring.
Pt had incision made in anterior neck and skin & subQ tissues dissected.  Platysmal flap mobilized.  Strap muscles lateralized.  Rt thyroid mobilized.  Superior pole of thyroid skeletonized and then divided.  Lateral portion of thyroid gland on rt was elevated and recurrent laryngeal nerve was identified and confirmed with NIM monitor.  Pt had nerve dissected back to thyroid cartilage and larynx.  Pt had middle thyroid vessels divided and the gland completely mobilized.  Berry's ligament divided. Gland taken up over trachea and divided between clamps at level of isthmus.  Area irrigated and drain placed and wound closed in standard fashion.

Thank you in advance!


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## CVR (Oct 29, 2009)

from a Karen Zupko seminar, we learned that the nerve monitoring is reported by a physician other than the operating surgeon. "Medicare considers intraoperative monitoring part of the global surgical pkg. for primary, co- or assistant surgeon"


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## jackjones62 (Oct 31, 2009)

Yes, but the AAO supports the billing of NIMS and some private carriers do pay; so, in answer to your question is to bill as follows:

Right Thyroid Lobectomy:  60220
Laryngeal nerve:   95865-26
Intraoperative neurophysiology testing per hr: 95920-26 (x2 hrs/units)

Provided the hospital owns the equipment and the surgeon applies the electrodes and stimulates the nerve intraoperatively we can bill for the professional component, hence modifier 26; if the hospital does not own the equipment rents it per case and the company provides its own tech, than we cannot bill for any of it.

Jennifer
CT ENT


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