Neurology & Pain Management Coding Alert

Find out how to capture technical reimbursement in a facility setting

Reporting intraoperative monitoring (IOM) can open up a coding can of worms--from non-covered baseline studies to abandoned modifiers. Review these FAQs to make sure you-re not committing some common errors in your 95920 coding. Question 1: What is IOM and how do I report it? Answer: Intraoperative monitoring is the ongoing electrophysiologic testing and monitoring that a neurologist performs to ensure a patient's stability and protection from nerve damage during surgery. You should report this service using time-based, add-on code 95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]).
 
Because 95920 is an add-code, never report it as a stand alone code. When you perform IOM, you first need to complete a baseline study to establish a means of comparison. Report 95920 with the appropriate companion code for this baseline, such as 95860 (Needle electromyography; one extremity with or without related paraspinal areas). For more information: CPT includes a full list of allowable companion codes in its descriptor for 95920.

Important: You can perform and separately code multiple baseline studies, but -you only bill the IOM as one line unit,- cautions Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver. As a time-based code, the total units of 95920 that you report are based solely on monitoring time and not the number of studies performed.

Warning: Don't forget to subtract out from IOM the time involved in setting up, conducting and interpreting the baseline study(ies), says Hammer. Also, don't count your -standby time- as intraoperative monitoring, such as waiting in the operating room for the surgeon to arrive. Rule of thumb: Start your clock for IOM immediately after the surgery begins. Timing is Everything Question 2: If I perform IOM for less than one hour, should I append modifier 52 (Reduced services) to 95920?

Answer: According to the majority of coding experts and AANEM guidelines, modifier 52 is not required when reporting 95920. However, you should only bill for IOM if you provide monitoring for at least thirty-one minutes. Any amount of monitoring time less than that should not be reported at all.

Similarly, when reporting more than one unit of 95920, you need to make sure that you record more than 30 minutes of additional monitoring time, says Tiffany Schmidt, JD, policy director for the AANEM. Example: After subtracting out time for a baseline study, you are able to document IOM for two hours and thirty-five minutes. You can bill for three units of 95920 with the appropriate testing code. But if you recorded two hours and twenty minutes of IOM, you would need to limit your reporting to 95920 [...]