Neurology & Pain Management Coding Alert

Have you got your intraoperative monitoring services coding under control? Maybe not, coding experts advise. If you're reporting only 95920, you could be losing out on hard-earned reimbursement. 1. Report the 'Baseline' Study and Monitoring Separately Prior to performing intraoperative monitoring (+95920, Intraoperative neuro-physiology testing, per hour [list separately in addition to code for primary procedure]), the physician will conduct a "baseline study," which you may report separately and for which you should receive additional reimbursement. The neurologist must perform a baseline study to provide a basis for comparison during the monitoring. Intraoperative neurophysiological testing allows the physician to monitor the nervous system, its blood supply or adjacent tissue during surgery. Such monitoring can identify neurologic impairment, locate or separate nerve structures and determine which nerves remain functional, thereby allowing the operating surgeon to alter the surgery, if necessary, to avoid permanent neurological damage. Baseline studies may include auditory-evoked potentials (92585), sleep EEG (95822), EMG (95860-95861 and 95867-95868), nerve conduction studies (95900 and 95904) and evoked potentials (95925-95937), according to CPT. Individual carriers may also allow additional procedures, such as EEG (95812-95827, 95950-95954 and 95956) and central auditory testing (92589). You may report multiple baseline studies individually (for instance, if you perform both sleep EEG and an EMG, you may bill for each). You should report intraoperative monitoring itself using 95920. This is an "add-on" code that must accompany the codes that describe the baseline studies, according to CPT guidelines. "CPT clearly indicates that you should not count the time spent performing or interpreting a baseline electrophysiologic study as intraoperative monitoring," says Tiffany Schmidt, JD, policy director for the American Association of Electro-diagnostic Medicine (AAEM). "Code 95920 includes only that time spent on ongoing electrophysiologic monitoring during surgery, with the baseline study billed separately" she says. 2. Track Your Time Carefully Keep in mind that code 95920 is time-based and billed "per hour," with each hour representing one "unit" (of time and reimbursement) on the CMS-1500 claim form. Convert time to increments of 0.5 units, in which the first 30 minutes equals 0.5 units, 60 minutes equals one unit, and so on, as follows: Time         HCFA-1500 1-30 minutes 00.5 31-60 minutes 01.0 61-75 minutes 01.0 76-90 minutes 01.5 91-120 minutes 02.0, etc . Always report only the actual time the physician spent on intraoperative monitoring. This must be time the physician spent actively monitoring the patient and does not include "standby time" in the operating room waiting for the surgery to begin, says Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School [...]