Otolaryngology Coding Alert

Question: An otolaryngologist performs unilateral thyroid surgery with laryngeal nerve monitoring using a special endotracheal tube that has electromyography (EMG) sensors attached to it. Should I report 95868-26 for the endotracheal tube monitoring, or is this code for only needle electromyography?

Also, the endotracheal tube and attached monitor automatically monitors both vocal cords. The surgeon, however, only cares about monitoring the surgery-side vocal cord, because no risk exists for the other one. Should I use the unilateral code or the bilateral code?

Hawaii Subscriber

Answer: You should bill 95867-26 (Needle electromyography; cranial nerve supplied muscle[s], unilateral; Professional component) to private payers, provided your otolaryngologist's documentation supports the service. Monitoring documentation should include the surgeon's dictated report as well as the facility chart (sensor graphing or operating log).

Even though 95867 and 95868 (... cranial nerve supplied muscles, bilateral) describe needle EMG, you should also be able to use the code for the endotracheal tube monitoring. Sometimes, technology moves faster than CPT's code descriptions can keep up with the developments. The surgeon is using EMG technology to monitor cranial nerve muscles, just not needle EMG. So, 9586x appropriately describes the service.

You should submit unilateral code 95867, not bilateral code 95868. No medical necessity exists for monitoring the nonsurgical side, so you shouldn't bill the bilateral monitoring even though the machine had this capability.

Warning: Don't report 9586x to Medicare. Medicare won't pay for monitoring when the operating physician performs the service.