Otolaryngology Coding Alert

Reader Question:

Tip: No Modifier Will Bypass 95920/42415 Edits

Published on Mon Oct 10, 2011

Question: I got a denial from an HMO stating that 42415 includes 95920. What is the rule on this?

Ohio Subscriber

Answer: The CCI edits actually lists 95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]) as inclusive to 42415 (Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve), with a modifier indicator of "0." An indicator of "0" does not allow a procedure code to bypass the edits by using modifier 59 (Distinct procedural service) every time you bill that service.

Additionally, many payers -- including Medicare -- consider facial nerve monitoring (95920) integral to the surgical procedure (42415). Some will pay it if it is done by a physician other than the surgeon. Others will not pay it no matter who performs the monitoring.

Make sure if and when you bill interoperative nerve monitoring that you bill the base code to which 95920 is added. 95867-26 Needle electromyography; cranial nerve supplied muscle(s), unilateral is performed, documented and coded if the case is a parotid or an ear and 95920 times the number of units is added on for the number of hours the nerve is monitored. 95868-26 Needle electromyography; cranial nerve supplied muscles, bilateral, is performed, documented and coded if the case is a thyroid and 95920 times the number of units is added on for the number of hours the nerve is monitored.

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