Otolaryngology Coding Alert

Your monitoring claim will be incomplete if you forget to look for these details.

When choosing the test code, go beyond "cranial" to look for the specific nerve monitored.

VIIth nerve: Facial nerve monitoring, such as may be necessary for parotids, mastoids and acoustics, falls under 95867 (Cranial nerve supplies muscle(s), unilateral). In facial nerve monitoring, an instrument sounds an alarm when a muscle innervated by the seventh (VIIth) nerve is activated, explains Robert C. Fifer, PhD, associate professor and director of audiology and speech pathology for the Mailman Center for Child    Development at the University of Miami. "This is passive monitoring and does not require ongoing active attention or decision-making unless the alarm sounds."

Payment: "More often than not, third party payers will not pay for passive intraoperative monitoring. Fifer adds. "But the probability of reimbursement improves if there is medical necessity for someone apart from the surgeon to be actively engaged in intraoperative monitoring and exercising ongoing clinical judgment."

VIIIth nerve: The code combination +95920 (Intraoperative neurophysiology testing, per hour) with 92585 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive) requires ongoing attention and decision-making relative to whether a waveform is present and stable from the eighth (VIIIth) cranial nerve or auditory nerve, such as with posterior fossa, acoustic neuroma or skull base surgeries. If the waveform shows changes, the person providing the monitoring has to determine whether those changes are due to OR conditions or an actual change in the nerve's status.

Pay attention to the documented monitoring time. "The 95920 would be the hourly code for intraoperative monitoring with the number of units billed," points out Gloria Galloway, MD, FAAN, FABEM, professor of the division of neurology and director of the Intraoperative Monitoring Program for Children's Hospital at Ohio State University. The documentation in the medical chart should list the start-time and the end-time for the active monitoring to support the number of units billed to the third party payer.

Don't miss: The audiologist or non-operating surgeon must perform at least 30 minutes of monitoring to report the code, states the American Academy of Otolaryngology.

Round up from the last 30 minutes when calculating the units, adds Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J. Do so using these guidelines:

- If the non-operating surgeon spends an hour and 40 minutes monitoring, charge two hours of 95920.

- For an hour and 25 minutes of monitoring, charge only one hour.

You-ll be overbilling 95985 and 95920 if the hospital owns the monitoring equipment and if you don't add modifier 26 (Professional component). "If the clinician performs only the interpretation and does not own the equipment, modifier 26 must be appended to the code used for the study performed," according to the AAO-HNS.

Exception: "If the otolaryngologist or the audiologist owns the equipment and brings it to the operating suite, it is customary for the audiologist to bill the global fee for both 95920 and 92585," Fifer says.