Otolaryngology Coding Alert

Question: We billed 60240 with diagnosis codes 240.9 (Goiter, unspecified) and 242.00 (Toxic diffuse goiter; without mention of thyrotoxic crisis or storm). We also billed 95865 with the same codes, but the payer denied the claim. We are using facility equipment for the monitoring. What are we doing wrong?

Illinois Subscriber

Answer: You should report intraoperative nerve monitoring to payers that do not bundle it into the procedure as follows:

• 60240 -- Thyroidectomy, total or complete

• 95865-26 -- Needle electromyography; larynx; Professional component

• +95920-26 -- Intraoperative neurophysiology testing, per hour (List separately in addition to code for primary procedure); Professional component.

Bear in mind: To indicate intraoperative nerve monitoring, you need to bill +95920 as add-on code when you bill 95865.

Modifier 26 indicates that a professional aspect of the procedure was done and is used for the physician component. The facility bills for the equipment with modifier TC (Technical component).

Catch: Medicare will not pay for intraoperative nerve monitoring, but there are a few private payers that will.