Anesthesia Coding Alert

Question: Our anesthesiologist indicated on the charge ticket that he monitored the motor evoked potentials (MEP) testing during surgery. Can you explain the proper use of +95920?

Florida Subscriber

Answer: Code +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]) is an add-on code, and you can only bill it with one of the listed primary or "parent" codes. Report the parent codes, such as 95928 (Central motor evoked potential study [transcranial motor stimulation]; upper limbs) or 95929 (. . . lower limbs), for the performance and interpretation of the baseline diagnostic study(ies). Each baseline study performed requires a documented interpretation report from your anesthesiologist or the physician who performed the actual monitoring.

Heads up: In most cases in addition to the intra-op monitoring technician in the operating room, there is a neurologist or physiatrist providing the professional component of the initial neurophysiologic diagnostic study and intra-op monitoring online in real-time.

There are Medicare carriers who have some variation of the following rule: "This test must be requested by the operating surgeon and the monitoring must be performed by a physician." But the physician in this case cannot be the operating surgeon, the surgical assistant, or the anesthesiologist performing the anesthesia.

Double check: Be sure your anesthesiologist interpreted the baseline studies, monitored the intraoperative neurophysiologic tests during the surgery, and adequately documented these services. If, in addition to the technician in the OR performing the technical component of the intraoperative monitoring, there was an off-site physician performing the professional component, then more than likely your anesthesiologist would not be able to separately report the neurophysiologic monitoring in addition to his anesthesia services.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver; and Kelly Dennis, MBA, CPC, ACS-AP, with Perfect Office Solutions of Leesburg, Fla.