Anesthesia Coding Alert

Question: How should I bill for intraoperative neurophysiology monitoring and somatosensory evoked potentials? The codes are 95920 and 95925-95927. I am interested in any Health Care Financing Administration (HCFA) regulations regarding these services as well as information about supervision requirements, professional versus technical components and billing pitfalls.

Marcella Buckman
University of Nebraska Medical Center, Omaha

Answer: Neurophysiology monitoring and somatosensory evoked potentials are billable to Medicare and other carriers. When submitting claims to other carriers, remember that the regulations for covered/noncovered services are in their policy handbooks, which coders rarely have access to. Code 95920 (intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]) is an add-on code, so you must use it in conjunction with the primary procedure. CPT 2000 lists quite a few appropriate codes to use it with, including 92585 (auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system), 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) or 95904 (nerve conduction, amplitude and latency/velocity study, each nerve; sensory or mixed).

All of these codes can be billed without modifiers (indicating you own the equipment and did the test and report), with modifier -26 (professional component) or with -TC (technical component) if you work for a facility. Codes 95925-95927 (short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs; in lower limbs; in the trunk or head) would use the same modifiers as appropriate.

Modifier -50 (bilateral procedure) is not appropriate for any of these codes. Rules for medical direction or physician supervision are pending; this indicates that the HCFA has not published any decision on the requirements for postpayment review of these codes. No supplies can be billed with these codes. In many hospitals, these services are provided by a neurologist or neurology/neurosurgery technician and billed by a neurology or neurosurgery department/office. A report documenting the anesthesiologists involvement must be completed and placed in the patients chart.