Neurology & Pain Management Coding Alert

Question: What are the correct codes for interpretation of an intraoperative, free running EMG and pedicle screw stimulation? Is there a code we can report for online monitoring when the neurologist monitored the patient from outside the operating room?

North Dakota Subscriber

Answer: For pedicle screw stimulation, the provider performing the intraoperative electrophysiologic monitoring is usually evaluating free-run and triggered electromyography. CPT® does not list separate codes for a free running EMG. Simply report one of the standard EMG codes, such as 95861 (Needle electromyography; 2 extremities with or without related paraspinal areas) or 95870 (... limited study of muscles in 1 extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters). The electromyography code reported would include both the free-running EMG and pedicle screw stimulation.

CPT® does include a code for intraoperative monitoring (IOM) time: +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]). It is common for the two components (technical and professional) to be performed by two providers. Often a technician is physically present in the OR while most payers allow for remote online IOM by the physician and do not require the physician to be physically present in the OR. The physician's services in this scenario are typically reported with modifier 26 (Professional component). Note that +95920 is an add-on code, which means you can only report it in conjunction with certain primary procedures, such as the 95861 or 95870 EMG codes.