Neurosurgery Coding Alert

Question: During spinal surgery, we communicate with the intraoperative monitoring specialist to assess the integrity of the tissue. Placing pedicle screws additionally requires the surgeon's direct stimulation of the pedicle screw to assess breach of cortex. May we bill for the professional fee involved in surgical monitoring?

California Subscriber

Answer: If the surgeon merely "communicated" with the specialist and/or stimulated the pedicle screw, you may not report any portion of +95920 (Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]).

CPT guidelines specify that 95920 includes "recording, interpretation by a physician and report" and notes, "for interpretation only, use modifier -26 [Professional component]." Therefore, under CPT guidelines, the physician may report the professional component of modifier -26 if he or she interprets the testing data, either during or following the procedure, and no other physician (such as a neurologist) provides the same service.                                                                        

As a standard convention supported by the American Academy of Electrodiagnostic Medicine (AAEM), however, if the physician is operating on the patient (as in your question), he or she cannot simultaneously interpret the results of intraoperative testing. Therefore, if you are billing for a payer that follows CPT guidelines, and the surgeon interprets the test results (which no other physician has interpreted) following the procedure, he or she may report 95920-26.

According to Medicare guidelines, the physician must be present and interpreting the test results in "real time" (that is, during the procedure) to claim 95920, and a physician performing the surgery cannot do this. For Medicare payers, therefore, the physician cannot claim separate reimbursement for any portion of 95920 even if he or she interprets the results following surgery.