Neurology & Pain Management Coding Alert

Question: My neurologist performed intraoperative monitoring (IOM) inconjunction with upper extremity SSEP testing. How do I account for the time to perform the baseline study when billing the IOM time-based code?

Arizona Subscriber

Answer: You should bill the evoked potential code 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), which will cover the usual baseline test time of 20��"60 minutes.

The CPT section guidelines directs neurologists stating: "The time spent performing or interpreting the baseline electrophysiologic study(s) should not be counted as intraoperative monitoring, but represents separately reportable procedures." You should add one unit of 95920 (Intraoperative neurophysiology testing, per hour) for each additional 60 minutes of monitoring beyond the time spent performing the baseline studies.

You should also use modifier 26 (Professional component) when reporting these services, regardless of the location of the attending physician. By appending modifier 26, you show that your neurologist read and interpreted the test but does not own the equipment used for the test.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.