Otolaryngology Coding Alert

Question: My otolaryngologist performs 69641 (Tympanoplasty with mastoidectomy [including canalplasty, middle ear surgery, tympanic membrane repair]; without ossicular chain reconstruction) in an outpatient setting. Should I separately bill for facial nerve monitoring with an evoked potential study?

Massachusetts Subscriber

Answer: Because the otolaryngologist in your scenario provides the monitoring and the surgery, the billing depends on the insurer. Medicare does not pay for interoperative facial nerve monitoring when performed by the operating surgeon. But, if the patient has private insurance, you should report the testing (95927, Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head) and the monitoring (+95920, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]). For a Medicare patient, you may track the codes at a zero fee to account for the relative value units and the work that the physician performs.

For third-party insurers, be sure to bill the study first, followed by the add-on code for the monitoring. Do not count time performing and interpreting the evoked potential study as interoperative monitoring. Encourage your otolaryngologist to carefully document the start and stop times so you may code for the total monitoring time. You should report one unit of 95920 for each hour of documented monitoring. An hour is reached when 30 minutes has passed, so if the surgeon provides 90 minutes of monitoring time, you should assign 95920 x 2.

The National Physician Fee Schedule Relative Value File divides 95920 and 95927 into professional (modifier  -26) and technical (modifier -TC) components. Therefore, the facility that owns the monitoring equipment reports the technical component of the codes: 95920-TC and 95927-TC. You should append modifier -26 to the monitoring and testing codes (95920-26 and 95927-26) to indicate that you are billing only for the physician's work.