Neurology & Pain Management Coding Alert

Question: I am wondering if you have any information about coding and reimbursement for intra-operative monitoring of thyroidectomy cases.-We have a neurologist in our practice who does many of these cases and we receive denials from Medicare and other carriers because of the diagnosis. Do you have any information that might be of assistance to us? New York Subscriber Answer: Your denials are most likely driven by payer coverage policies. The diagnosis reported probably does not meet the payer's medical necessity criteria.-Many payers do not include the typical diagnoses for thyroid or radical neck dissection surgeries as medically necessary for intraoperative monitoring or the baseline diagnostic studies, such as somatosensory evoked potentials (SSEP), motor evoked potential (MEP), electromyogram (EMG), etc.-These diagnostic studies-are reported as the "parent" or "primary" code(s) for the add-on intraoperative monitoring code, +95920 (Intraoperative neurophysiology testing, per hour [List separately in addition to code for primary procedure]). [...]