Neurology & Pain Management Coding Alert

Specific procedures/surgeries are eligible for intraoperative monitoring. The following list is based on a typical local medical review policy, but different carriers may determine what is acceptable to accompany a claim of 95920 (intra-operative neurophysiology testing, per hour [list separately in addition to code for primary procedure]):
 
Surgery of the aortic arch, its branch vessels, or thoracic aorta, including carotid artery surgery, when there is risk of cerebral ischemia
 
Resection of epileptogenic brain tissue or tumor
 
Resection of brain tissue close to the primary motor cortex and requiring brain mapping
 
Protection of cranial nerves:
  - tumors affecting optic, trigeminal, facial, auditory nerves
  - cavernous sinus tumors
  - microvascular decompression of cranial nerves
  - oval or round window graft
  - endolymphatic shunt for Mnire's disease
  - vestibular section for vertigo
 
Correction of scoliosis or deformity of spinal cord involving traction on the cord
 
Protection of spinal cord where work is performed close to the cord, such as in placement or removal of hardware
 
Spinal instrumentation requiring pedicle screws or distraction
 
Decompressive procedures on the spinal cord or cauda equina carried out for myelopathy or claudication where function of spinal cord or spinal nerves is at risk
 
Spinal cord tumors
 
Neuromas of peripheral nerves of brachial plexus, when there is risk to major sensory or motor nerves
 
Surgery for intracranial arteriovenous (AV) malformations
 
Surgery for arteriovenous malformation of spinal cord
 
Cerebral vascular aneurysms
 
Surgery for intractable movement disorders
 
Arteriography, where there is a test occlusion of the carotid artery
 
Circulatory arrest with hypothermia (does not include surgeries performed under circulatory bypass, e.g., coronary artery bypass graft (CABG), ventricular aneurysms)
 
Distal aortic procedures, risking ischemia to spinal cord
 
Leg-lengthening procedures, where there is traction on sciatic nerve or other nerve trunks
 
Basil ganglia movement disorders
 
Surgery as a result of traumatic injury to spinal cord/brain
 
Deep brain stimulation.
The physician billing for intraoperative monitoring must perform the service in real-time and perform no additional service. Also, a number of local medical review polices specify, "In the event of postpayment review for medical necessity, the patient's medical record must support the need for the studies performed. The number of limbs or areas tested should be minimum to evaluate the patient's condition. Repeat testing should be infrequent. An excessive number of services may result in payment delay or denial."