Increase Your Bottom Line by Correctly Coding Intraoperative Monitoring
Published on Tue Feb 01, 2000
Neurologists performing intraoperative monitoring play a crucial role in many complex and delicate surgeries. Intraoperative monitoring allows physicians to ensure that the brain, spinal cord and other complex mechanisms and nerves are not compromised during a procedure. Coding for this service can also be a highly complex operation.
The CPT code for intraoperative monitoring is 95920 (intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]).
This is an add-on code that must be listed separately in addition to a primary procedure.
Neurologists May Not Be in the OR at All Times
Douglas M. Loop, CPA, administrator of Loma Linda University Neurology Associates, a 14-provider practice in Loma Linda, Calif., says that the neurologist usually is present at the beginning and end of surgery, personally ensuring that when the patient is going under and coming out of anesthesia that all the nerves are working normally. He or she also will monitor the movement of the extremities to ensure that they are moving properly. But the physical presence of the neurologist throughout a procedure is not always required. Often, a neurologist will have a technician remain on site to monitor the results while the neurologist is on call, available by pager or other means.
The neurologist may use remote video monitors to observe the surgery and monitor a readout at the same time. Also, a neurologist can use a laptop computer that is connected to the monitoring equipment so he or she can be mobile and still monitor the surgery from an off-site location. If problems arise, the neurologist can return to the operating room immediately.
The primary procedures fall into three categories, which Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pennsylvania Medical Center at Shadyside in Pittsburgh, and president of the American Association of Electrodiagnostic Medicine (AAEM), defines as follows:
1. Electroencephalogram (EEG): For examples, 95816 (electroencephalogram [EEG] including recording awake and drowsy [including hyperventilation and/or photic stimulation when appropriate]) and 95812 (electroencephalogram [EEG] extended monitoring; up to one hour)
2. EMG and Nerve Conduction Studies: For examples, 95860 (needle electromyography, one extremity with or without related paraspinal areas) and 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study)
3. Evoked Potential Studies: For examples, 92585 (auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system) and 95925 (short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs)
Busis cites a carotid artery surgery (60605) as a prime example of EEG intraoperative monitoring. During this procedure, the EEG monitoring allows [...]
