Neurology & Pain Management Coding Alert

Intraoperative neurophysiological testing monitors a patient for complications during surgery. Only one code (95920, intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]) is used to report this service, but receiving proper reimbursement is complicated by many regulations governing its use. Among these, add-on code 95920 must be listed with an appropriate primary procedure code, an acceptable diagnosis must accompany the claim, and  documentation and place-of-service guidelines must be met.
What's Involved?
Intraoperative neurophysiological testing identifies and/or prevents complications during surgery on the nervous system, its blood supply or adjacent tissue. Such monitoring can identify neurologic impairment, locate or separate nerve structures, and determine which nerves remain functional. Evoked responses are monitored throughout the surgery for changes that may imply damage. According to Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, consultant and CPC trainer for A+ Medical Management and Education in Egg Harbor City, N.J, this allows the surgeon to alter the procedure, if necessary, to avoid permanent neurological damage and reduce the danger. In some cases, high-risk patients undergo surgery only if intraoperative testing is available.
Code the Procedure
Intraoperative monitoring is provided in addition to other electrophysiologic studies, e.g., electromyography (EMG), nerve conduction studies (NCS), or electroencephalograms (EEG), which establish a baseline for comparison during the surgery. According to CPT, 95920 describes ongoing electrophysiologic testing and monitoring during surgical procedures (regardless of the exact study performed), and includes only that time spent on ongoing electrophysiologic monitoring, says Barbara J. Cobuzzi, CPC, CPC-H, MBA, president of Cash Flow Solutions Inc., a Lakewood, N.J., billing company. Time spent providing or interpreting baseline electrophysiologic study(ies) does not count toward intraoperative monitoring and should be reported separately.
 
CPT-listed baseline studies that may be billed in addition to 95920 include auditory-evoked potentials (92585), sleep EEG (95822), EMG (95860-95861 and 95867-95868), NCS (95900 and 95904) and evoked potentials (95925-95937). Individual carriers may allow additional procedures, however, such as EEG (95812-95827, 95950-95954 and 95956), and central auditory testing (92589).
 
Multiple baseline studies may be reimbursed individually, i.e., if both NCS and EMG are performed, each may be billed, Cobuzzi says, but report only one unit of 95920 per hour regardless of the number of electrophysiologic studies performed.
 
Always report the actual time (one unit of service per hour) spent on intraoperative monitoring (in the operating room, not "standby time"). The time should be reported in the appropriate "units" field according to the examples listed below.
 
Time       HCFA-1500
1-30 minutes  005
31-60 minutes  010
61-75 minutes  010
76-90 minutes  015
91-120 minutes  020
Note: Time is converted to increments of .5 units. The first (1-30 minutes) equals .5 units; 76-90 minutes equals 1.5 units, etc.
 
Although not all carriers request the information, it is wise to document the exact start and stop times. Modifier [...]