Neurology & Pain Management Coding Alert

Question: My neurologist goes into the operating room to monitor a patient's nerves during surgery. However, the diagnosis for the electromyogram (EMG) winds up being different from the intraoperative monitoring (IOM) code. Which diagnosis should I use?

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Answer: If the neurologist performs electrodiagnostic testing such as EMG, evoked potentials, or nerve conduction studies (using, for instance, 95860-95864; 95925-95937; 95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study; or 95904, ... sensory), you should cite the same diagnosis you used to create the medical necessity for the IOM. This is typically the diagnosis you use to establish the need for the surgery.
 
For example, the patient undergoes lumbar spinal fusion at multiple levels due to lumbar spinal stenosis (721.4x, Lumbar spondylosis with myelopathy). The surgeon will probably use 721.4x, and the anesthesiologist will use this code as well. Therefore, the neurologist performing the baseline electrodiagnostic testing with IOM should also use this code to create medical necessity for the CPT codes he submits (including the baseline study and the IOM, +95920, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]).