Neurology & Pain Management Coding Alert

Clarify your questions with this aneurysm clipping example

When reporting intraoperative monitoring (95920), remember these four points: Always claim a baseline study, apply necessary modifiers, track time carefully, and follow the surgeon's lead when selecting a diagnosis.

For a demonstration of these points in action, consider this case study:

The patient: A 58-year-old male with a 17-mm intracranial aneurysm (437.3, Cerebral aneurysm, nonruptured).

The scenario: The patient must undergo surgery for microsurgical clipping of the aneurysm (61697, Surgery of complex intracranial aneurysm, intracranial approach; carotid circulation). The operating neurosurgeon requests that the neurologist provide intraoperative monitoring to ensure the patient's stability throughout the procedure and to provide warning should the patient react badly to any portion of the surgery.
 
Prior to surgery, the neurologist must establish baseline values as a comparison point to track the patient's ongoing status during the procedure. In this case, the neurologist chooses an awake and drowsy electroencephalogram to provide the benchmark.

Surgery to clip the aneurysm lasts about two hours and 45 minutes, with the neurologist monitoring the patient's status throughout.

The coding: In this case, proper coding for the neurologist's role is:
   95816-26 (Electroencephalogram [EEG]; including recording awake and drowsy; Professional component), with a diagnosis of 437.3
   +95920-26 (Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]; Professional component) x 3 units, with a diagnosis of 437.3 Getting there: To understand how we arrived at this coding, consider the four points listed below:

1. Claim the Baseline Study Remember, 95920 is an add-on code - which means you should never report it alone. Remember, also, that the neurologist must provide a baseline study to establish a basis for comparison.

In other words, the baseline study is separate and distinct from the intraoperative monitoring, and you should report each procedure independently, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.

In this case, the neurologist provided an awake and drowsy EMG (95816) prior to intraoperative monitoring. But the neurologist may choose any number of electrophysiologic tests to establish a baseline. You can find a complete list of approved "companion codes" for intraoperative monitoring in your CPT manual following the 95920 descriptor. 2. Turn to -26 You should always append modifier -26 to 95920, as well as any baseline study code(s), when the neurologist provides these services in a facility setting, says Barbara Cobuzzi, MBA, CPC, CPC-H, coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.
 
Payment for these codes covers both the physician time and effort and the use and maintenance of the necessary equipment. The neurologist can only collect for the professional component of [...]