Otolaryngology Coding Alert

Question: An otologist wants to have an audiologist provide intraoperative nerve monitoring during inpatient surgical procedures. I know that CMS requires audiologists to bill directly for diagnostic audiological services but I’m not sure about billing for other CPT® codes. How should the physician bill for the monitoring and will the group’s carrier cover it for Medicare beneficiaries?

North Dakota Subscriber

Answer: Yes, an audiologist can perform intraoperative monitoring of the eighth nerve (92585, Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive) with +95940 (Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes [List separately in addition to code for primary procedure]). 

Do this: To indicate ongoing eighth nerve testing that could be necessary with acoustic neuroma or posterior fossa surgeries (such as 61520, Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor; and 61595, Trans-temporal approach to posterior cranial fossa, jugular foramen or midline skull base, including mastoidectomy, decompression of sigmoid sinus and/or facial nerve, with or without mobilization), use 95940 for each 15-minute increment the audiologist provides monitoring in addition to 92585.

Rationale: Code 95940 is not a stand-alone code: It must always be linked to the specific type of diagnostic procedure which, in the case of audiologists, would be 92585. Using 95940 shows that the test is not simply a one-time measurement of the auditory nerve status. Rather, it reflects ongoing, sequential measurements of auditory nerve (for audiologists) or whatever the primary monitoring procedure is.

Another tip: Make sure that the monitoring is billed under the audiologist’s NPI provider ID number so that the payer can see that the provider doing the nerve monitoring is separate from the surgeon.