Neurology & Pain Management Coding Alert

Question: Can you explain proper reporting of 95961 and 95962? And how can we report evoked potentials (e.g., 95925) for monitoring following mapping if mapping is not provided for the duration of the surgery?

Pennsylvania Subscriber

Answer: Codes 95961 (Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance) and +95962 ( each additional hour of physician attendance [list separately in addition to code for primary procedure]) describe cortical and/or subcortical functional mapping, for instance during epilepsy surgery to determine which part of the brain  should be removed, or during surgery to implant stimulators for treatment of Parkinsonian tremors. During the procedure, depth electrodes are used to identify vital cortical or subcortical structures. The same electrodes may be used to stimulate brain tissue or record brain cells during mapping.

Codes 95961 and 95962 are time-based, so documentation should note start and stop times. The initial hour of service is reported 95961, with each additional hour of continued monitoring beyond the first billed as 95962. Because 95962 is a designated add-on code, modifier -51 (Multiple procedures) need not be appended, even when billing multiple units. However, modifier -26 (Professional component) should be appended to these codes to indicate that only the professional component of the procedure is being billed.

In addition, according to CMS guidelines, 95961 and 95962 must be performed under the personal supervision of a physician, i.e., a physician must be in attendance in the room during the performance of the procedure.

Sensory evoked potentials (for instance, 95925, Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper limbs) are separate and distinct from 95961 and 95962. Therefore, if evoked potentials are used to monitor the patient following mapping, the appropriate evoked potential code(s) (95925-95927), along with the intraoperative monitoring code (+95920, Intraoperative neurophysiology testing, per hour [list in addition to code for primary procedure]) for each hour of continued monitoring, may be reported in addition to 95961/95962.

For example, during a three-hour surgery, mapping is provided for the first two hours and upper-limb evoked potentials are used to monitor the patient continually for the final hour. This service would be reported 95961 (first hour of mapping), 95962 (second hour of mapping), 95925 (baseline evoked potential), and 95920 (one hour of intraoperative monitoring).

Note that only one unit of 95925 can be used regardless of the number of nerves or dermatomes (skin sites) that are stimulated in each upper limb (on one or both sides). The same holds true for 95926 and 95927, i.e., only one unit of 95926 or 95927 can be billed regardless of the number of nerves or dermatomes stimulated in each lower limb or in the trunk or head, respectively. The professional services (modifier -26) portion of 95925-95927 must be performed under the direct supervision of a physician, but the technical portion (that portion of the service billed using modifier -TC [Technical component]) of the service may be performed by a technician with certification, under the general supervision of a physician.