Advanced Search

Otolaryngology Coding Alert

You Be the Coder:

95920, 42415: Why You Should Avoid This Code Combo

Published on Sat Nov 20, 2010

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: [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Otolaryngology Coding Alert

View All