Neurology & Pain Management Coding Alert

Question: I have been receiving conflicting information on 95920. Can this code be used with 95955? CPT does not show 95955 as a parent code for 95920. Also, can 95920 be used for any part of an hour, or must it include a full 60 minutes? Neurology Discussion Group Participant Answer: The answer depends on your payer. According to CPT, baseline studies typically billed with +95920 (Intra-operative neurophysiology testing, per hour [list separately in addition to code for primary procedure]) include auditory evoked potentials (92585), sleep EEG (95822), EMG (95860-95861 and 95867-95868), NCS (95900 and 95904) and evoked potentials (95925-95930). A sample of Medicare local medical review policies reveals that many carriers and third-party payers allow additional procedures, including EEG (95812-95827, 95950-95956) and central auditory testing (92589) and in some cases 95955 (Electroencephalogram [EEG] during nonintracranial surgery [e.g., carotid surgery]). CPT guidelines do not specifically preclude the reporting of any particular electrodiagnostic procedure in addition to intraoperative monitoring. If the neurologist performs 95955 preoperatively to establish a baseline for comparison, it may be reported separately if the individual payer will allow it. Because payer guidelines vary, your best strategy is to ask the individual payer prior to billing. Always report the actual time (one unit of service per hour) spent on intraoperative monitoring (in the operating room, not "standby time"). Designate time in the appropriate "units" field as demonstrated above: Note: Payers differ as to whether you should charge for half units or "round up" to the next whole unit. Ask your payer for guidelines. Although not all payers will request the information, it's a good idea to document the exact start and stop times for the monitoring. Note that modifier -51 (Multiple procedures) is not required for multiple units of 95920.