Otolaryngology Coding Alert

Question: I am trying to get my assistant surgeon paid for code 95920. Patient had a 42415 and I put a modifier 26 with it and it keeps getting denied as "payment does not get paid separately." What am I doing wrong?

Answer: You can't code +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]) with 42415 (Excision of parotid tumor or parotid gland, lateral lobe, with dissection and preservation of facial nerve). The Correct Coding Initiative (CCI) states that "intraoperative neurophysiology testing (95920) should not be reported by the physician performing an operative procedure since it is included in the global package. However, when performed by a different physician during the procedure, it is separately reportable by the second physician.

What this means is that Medicare requires that the operating surgeon request this test and the monitoring  performed by a physician other than:

• the operating surgeon;
• the surgical assistant;
• the anesthesiologist rendering the anesthesia.

It will only be paid when another practitioner performs the service (i.e., someone independent of your practice).

Additionally, if you read the CPT instructions with +95920, you will see that it is an add-on code, and it is not an add on to your surgical code but an add on code per the following directions: "(Use 95920 in conjunction with the study performed, 92585, 95822, 95860, 95861, 95867, 95868, 95870, 95900, 95904, 95925-95937)." You should use modifier 26 (Professional component) on the initial study done prior to the monitoring. In the case of a parotidectomy, the initial code for the non surgeon, dedicated monitoring practitioner would be 95867-26 (Needle electromyography; cranial nerve supplied muscle[s], unilateral) and 95920 times the number of hours monitored.