Neurosurgery Coding Alert

Question: We have two surgeons co-performing a corpus callosotomy, with one planning on also performing intraoperative monitoring. Can this surgeon bill out for the primary surgical procedure in addition to the intraoperative monitoring codes?

Texas Subscriber

Answer: As of January 2013, a surgeon is not allowed to bill for both the surgical procedure and the intraoperative monitoring. It's required that a separately licensed professional conduct the intraoperative monitoring during the course of the procedure. This rule also extends to co-surgeons, as per the above example. With this information, the co-surgeon would not be an eligible candidate to perform the intraoperative monitoring. As per Medicare guidelines, any one of the following is eligible to perform intraoperative monitoring during a surgical procedure:

• A physician who is not performing the procedure,
• An audiologist trained and certified in electrophysiologic monitoring,
• A physical therapist trained and certified in electrophysiologic monitoring, or
• A neurophysiologist, neurologist, or physiatrist.

Note: This does not necessarily mean that a qualified physician assistant (PA) or nurse practitioner (NP) is not eligible to perform intraoperative monitoring. However, in order to determine the full scope of eligibility, you should contact the physician's provider-relations representative. Training and certification in electrophysiological monitoring within scope of practice as determined by the state medical board are parameters typically required of most payers to report these procedures.