Reader Question:
Coding Ethically
Published on Sat Jul 01, 2000
Question: Our neurosurgeon had a neurologist provide the technical component for intraoperative monitoring (95920, intraoperative neurophysiology testing, per hour) during various surgical procedures. The neurosurgeon has asked the neurologist to give him all the data collected during the intraoperative monitoring so that he can bill for the professional component of 95920. Is this proper and ethical coding?
New York Subscriber
Answer: Scott Groudine, MD, at Albany Medical Center in Albany, N.Y., provides the following policy information to help address this issue. Neurosurgeon cannot bill a professional component for services under 95920. Further, the technical component usually is not charged by the professional providing the intraoperative monitoring because even when the neurologist is on site with equipment he or she may have provided, the hospital still will charge the technical component for its electricity and space. Generally, neurologists do not have their own equipment, but even if they do, hospitals probably still will charge the technical component.
From Groudines local Medicare carriers policy, Medicare requires that this test be requested by the operating surgeon and the monitoring must be performed by a physician, other than the operating surgeon, the technical/surgical assistant, or the anesthesiologist rendering the anesthesia.
Empire NY, a local New York Blue Cross/Blue Shield carrier, states: The intraoperative testing is a support service provided to the operating surgeon by a physician other than the anesthesiologist or a member of the surgical team, i.e. the assistant surgeon. If the intraoperative testing is reported by the anesthesiologist or assistant surgeon, it will not be allowed.
The local New York branch of United Health Care, which provides traditional health insurance plans and Medicare HMOs, has the following policy: 95920-PC is a Part B service. This includes the actual time spent by a neurologist/neurophysiologist or similar specialty trained physician during an operative procedure when his/her expertise is medically necessary. The amount of time spent, with corresponding data supporting medical necessity, should be documented.
If the neurologist provides this equipment, he or she should check with the hospital and major carriers concerning the use of modifier -26 (professional component) because it is the only professional component that the provider of the monitoring will be able to charge and seek reimbursement.
