Neurology & Pain Management Coding Alert

Remember, 95920 is an add-on code - which means you should never report it alone. Remember, also, that the neurologist must provide a baseline study to establish a basis for comparison.

In other words, the baseline study is separate and distinct from the intraoperative monitoring, and you should report each procedure independently, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.

In this case, the neurologist provided an awake and drowsy EMG (95816) prior to intraoperative monitoring. But the neurologist may choose any number of electrophysiologic tests to establish a baseline. You can find a complete list of approved "companion codes" for intraoperative monitoring in your CPT manual following the 95920 descriptor.

2. Turn to -26

You should always append modifier -26 to 95920, as well as any baseline study code(s), when the neurologist provides these services in a facility setting, says Barbara Cobuzzi, MBA, CPC, CPC-H, coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.
 
Payment for these codes covers both the physician time and effort and the use and maintenance of the necessary equipment. The neurologist can only collect for the professional component of the testing - which you must indicate by appending modifier -26.

You are not responsible for billing separately for using the facility's testing equipment. The facility will collect separately for the use of its equipment by appending modifier -TC (Technical component) to the appropriate testing codes.

3. Document Monitoring Time

 You should report 95920 "per hour" of physician time, Cobuzzi says. You may report one unit of 95920 for each hour of physician time. To sustain your claim, however, you should be sure that you precisely document the time the neurologist spends.

In our example, the neurologist spends two hours, 45 minutes providing monitoring, allowing us to report three units of 95920.
 
Warning: When documenting intraoperative monitoring time, count only the time actually spent on intraoperative monitoring, Jandroep says. For instance, you can't count "standby time" in the operating room, while the neurologist waits for the surgeon to arrive, or the time spent to conduct the baseline study, as part of the intraoperative monitoring time.

4. Choose a 'Me Too' Dx

The diagnosis(es) you link to your intraoperative monitoring and baseline study codes should match the diagnosis that the surgeon uses to justify the primary surgical procedure, Jandroep says.

Think about it: The reason the surgeon asks the neurologist to monitor the patient arises from the same problem that the surgeon wishes to correct. And because the intraoperative monitoring prompts the need for the baseline study, they should share the same diagnosis, as well.

In our case, the reason for the surgery was an intracranial aneurysm (437.3). Therefore, we should link 437.3 to both 95920 and our baseline study (95816).