# Intraoperative Neuromonitoring @ Remote Location



## jenn468691 (Jan 28, 2010)

Our neurologists will soon be involved in providing intraoperative neuro monitoring services. We have employed an intraoperative neuromonitoring technician who will take our equipment to the OR and our neurologists will remotely monitor activity from our office. Some of the CPT codes used would be 95925, 95926, 95927, 95928, 95860, 95861, 95863, etc. 

Question 1: Since we own the equipment and are remotely monitoring may we bill global (for both the professional and technical component)?
Question 2: What is the most appropriate place of service...the neurologists are remotely monitoring in the office, the equipment/technician are in the hospital OR.

Any assistance would be appreciated.


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## Cindy Akkerman (Jun 15, 2010)

*Iom*

I see your post is older, but I am searching for a few answers myself on IOM, did you ever find some to answer these?


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## lisa2010 (Oct 29, 2010)

You can bill global only to commercial payors. Medicare and all Med. replacement policys will not pay for tc. You bill for 26 only 21/22 POS.  You have to have a contract with  the facility, they reimburse you and they bill to ins. 

When you bill for global the chances of being paid global are hit and miss. They are expecting a 26 only. More and more ins co. are refusing to pay the TC. Medicare states that you have to be contracted with the facilty. But, the ins policys state that a tech preforms the tests  with a monitoring physician and yet the ins. co do not contract tech. You have to fight for the TC. I would like to start some type of investigation, because I know that the facilitys are billing for tech. because they know they can and they refuse to contract IOM providers because the would lose money. They do have at least one company contracted so they can justify billing for it. sneaky! (sorry, this fustrates me)

Code 95920 is performed in the hospital setting. Monitoring of a patient with code 95920(add on code to 95925-95926+) should use Hospital site of service (site 21), or Hospital Outpatient surgery center (site 22), even if the monitoring physician is located in an office. When supervising and interpreting IOM on a hospitalized patient, the supervising physician codes using modifier -26.

I have been billing for IOM, Neurosurgery and Neurology for YEARS!   I also contract bill if interested? Not being pushy , doesn't hurt to mention.


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## lisa2010 (Oct 29, 2010)

Probably should have mentioned that my last post is TX guidelines as far as the facilty contracts. It differs from state to state. However, Medicare is federal as you may know and those guide lines are law, so to speak!


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## coderguy1939 (Nov 22, 2010)

Hi, Lisa,

The only information I can find from Medicare re 95920 is in the NCCI Manual Chapter 4, H.General Policy, Item #12.

I can't find an NCD and our MAC does not have an LCD.

Where are you finding the specific requirements Medicare has regarding this procedure?

I appreciate your help.


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