# Your suggestion on this surgery



## nsclark2

I am asking for your input on how to code this surgery.  Procedure done: Total Thyroidectomy with bilateral recurrent laryngeal nerve dissection and preservation.  And Reimplantation of left superior parathyroid gland in the right sternocleidomastiod muscle. 

I coded the 60240 for the total thyroidectomy and 95865 for the nerve monitoring  (do we use modifier 26 with that?)  What do we need to use for the reimplantation? 

Thanks for all of your help!


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## jackjones62

Nicole, Based on what you provided, this is how I would code a total thyroidectomy w/bilateral nerve preservation & monitoring w/re-implantation of parathyroid gland:

60240 - Total Thyroidectomy
60512 - Parathyroid autotransplantation (add on code, no modifier)
95865-26 - Needle electromyography -Larynx
95920-26 - Intraoperative neurophysiology testing, per hour (add on code,  
                no other modifier) 

It is important with regards to the nerve monitoring that your surgeon includes this in their operative report and that they indicate how many hours the nerve monitoring was performed, 95920 is billed per hour, so if it took 4 hours, we bill 4 units.  There is controversy with regards to billing intraoperative nerve monitoring, there are some insurance carriers, Medicare included, that will not pay.  The Academy of Otolaryngology has a coding article on their website, you may want to take a look.

If anyone else has more info or other opinions, please, it's always good to get feed back.

Hope this helps,

Jennifer
ENT CT


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## nidhim

Hi Nicole,

Per CPT coding guidelines, CPT code 95920 *cannot* be reported by the surgeon and/or assistant surgeon, It can only be reported if the IOM is provided by a physician other then the surgeon either in the OR or remotely. 

Hope this helps,

Nidhi M.


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## arnette walker

I agree with the last posting, the surgeon, assist at surgery and or anesthesiologist cannot bill for the monitoring, must be done by a tech or qualified health provider not involved in the surgery.  Also the codes have changed from 95920 to 95940. 

A. Walker


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## MaryDx

Can't find where the assistant surgeon can't bill for intraoperative monitoring - it's not spelled out in the CPT manual - only mentions the surgeon or the anesthesiologist.  Is there another reference that specifically notes that? Thanks.


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## Candice_Fenildo

Mary, try this reference site. 

http://www.entnet.org/Practice/Coding-for-Intraoperative-Neurophysiology-Testing.cfm


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## MaryDx

Thank you, Candy!!


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