Neurosurgery Coding Alert

Question: My neurosurgeon performs intraoperative monitoring for a pedicle surgery. He stimulates the screw and checks for a motor nerve response. How should I report this?

Illinois Subscriber

Answer: The surgeon may not bill for intraoperative monitoring, including electromyography (EMG) for pedicle screw stimulation. If a neurologist performs the monitoring, you may bill for every hour spent monitoring the patient in the operating room, by reporting +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]).

Note: The baseline test must be complete. Also, intraoperative electrophysiologic monitoring involves free-run evaluation and triggered electromyography. Triggered EMG is when the physician stimulates the screw.

For free-run and triggered EMG testing, the neurologist should report 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) in addition to one unit of 95920 for each hour of monitoring the physician performs.