Otolaryngology Coding Alert

Question: An otolaryngologist excises the submandibular gland with nerve monitoring in the office. A local facility brought us the monitor for the procedure. Should I bill for the monitoring?

Washington Subscriber

Answer: When the same physician who performs the procedure, such as submandibular gland excision (42440, Excision of submandibular [submaxillary] gland), also provides the monitoring (+95920, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary service]), the billing depends on the payer. Medicare doesn't pay for intraoperative facial-nerve monitoring when the operating surgeon performs the testing. But you may bill private insurers for the study (95867, Needle electromyography; cranial nerve supplied muscle[s], unilateral) and monitoring (95920). For a Medicare patient, you may enter 95867 and 95920 at zero fees to track the physician's work and account for the test's relative value units.
 
For commercial payers, you should report the study first and then the monitoring add-on code (95920). You shouldn't include time performing and interpreting the study as intraoperative monitoring. Encourage your otolaryngologist to document monitoring start and stop times so you may bill for the total monitoring time. Report one unit of 95920 for each hour of documented monitoring. You may round up to an hour when the surgeon provides a 30-minute segment. So, if the otolaryngologist provides 41 minutes of monitoring time, you may report 95920.
 
The National Physician Fee Schedule divides 95867 and 95920 into professional (modifier -26, Professional component) and technical components (-TC, Technical component). Therefore, make sure you append modifier -26 to the study (95867) and the monitoring codes (95920) to indicate that you are billing for the physician's work only. The facility that owns the monitor will bill for the technical component with modifier -TC.
 
In summary, you should bill the scenario one of two ways. For a Medicare patient, bill 42440 only. You may report 42440, 95867 and 95920 to third-party payers.