Neurology & Pain Management Coding Alert

Question: Can I bill for facial nerve monitoring for 100 minutes in a hospital setting with a total thyroidectomy?

Florida Subscriber

Answer: The answer varies by the insurer. For example, Medicare only pays for nerve monitoring when performed by a physician who is not performing the main operation. If a physician performs both the facial nerve monitoring and the total thyroidectomy, you should bill Medicare only for the surgery with 60240 (Thyroidectomy, total or complete).

Exceptions: In rare cases, some private payers allow the operating physician to also bill for facial nerve monitoring. You-ll need to use three codes when reporting intraoperative facial nerve monitoring: one for the primary procedure (the surgery), one for the electrophysiologic study that accompanies the surgery, and one for the monitoring. In the scenario you describe, you would report the following:

- total thyroidectomy (60240)

- the bilateral study's professional component (95868-26, Needle electromyography; cranial nerve supplied muscles, bilateral; professional component)

- monitoring (two units of +95920-26, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]).

Don't forget: Use modifier 26 to indicate when the physician does not own the equipment and is billing only the professional component.