Otolaryngology Coding Alert

Question: An article in Otolaryngology Coding Alert Vol. 10, No. 10, states that an audiologist can bill for monitoring of the eighth nerve using 92585 with +95920. No COrrect Coding Initiative (CCI) edit prevents billing needle electromyography (EEG) monitoring of a cranial nerve (69930) with a cochlear implant (95867).-During an implant, can the audiologist bill +95920 and 95867?--

Indiana Subscriber

Answer: The problem is not whether 95867 (Needle electromyography; cranial nerve supplied muscle[s], unilateral) is bundled with the cochlear implant, but whether the intraoperative monitoring is included in the surgery. CCI includes intraoperative monitoring in the surgery when performed by the same surgeon. So, to bill the intraoperative monitoring (and hence the related study, such as the cranial nerve EEG), you have to have a different provider -- a separate national provider identifier (NPI) billing those items on a separate claim.

Know payers- rules: Code 95867 is not on Medicare's allowed list for codes that an audiologist can bill directly, but private payers may allow you to do so. Third-party payer's policies could allow you to separately bill intraoperative monitoring by the surgeon (same NPI).

You may, however, want to go back and talk to your audiologist about what monitoring she's actually doing.

If she's doing ongoing monitoring of the cranial nerve for ongoing attention and decision making relative to whether a waveform is present and stable, Robert C. Fifer, PhD, and the American Academy of Audiology say the correct codes are +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]) and 92585 (Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system; comprehensive). This combination is permissible with cochlear implant surgery.

In contrast, +95920 with 95867 represents passive monitoring. An instrument sounds an alarm when a muscle innervated by the seventh (VIIth) nerve is activated.