Neurosurgery Coding Alert

Tracking time, reporting baselines present the real challenge You-re not alone if you find yourself questioning how to report intra-operative monitoring (IOM) services. Neurosurgery coders in multispecialty clinics frequently see claims for intra-operative monitoring. Jo Helms, CPC, PCS, clinic coding specialist with Affinity Health Systems in Appleton, Wis., is just one of several readers who has requested guidance on how to report these services. "Recently, one of our neurologists began performing IOM for spinal procedures, and we have many questions about these services," Helms writes. She suggests that coding for multiple EMG studies can be especially confusing. Luckily, IOM claims are easy to handle if you remember the following four points.
1. Claim the Baseline Study Prior to performing IOM, the monitoring physician may first conduct one or more studies to establish a patient's "baseline" responses. You should report these baseline studies separately from the IOM. CPT provides a list of approved baseline studies/primary procedures for use with IOM, which includes EMG, nerve conduction studies, evoked potentials and others. You may report multiple baseline studies when necessary. For instance, if the monitoring physician performs both sensory evoked potentials (SEP) and an EMG baseline study, you may bill for both. However, under AMA/CPT rules, you should report the baseline electrophysiologic study only "once per operative session." An important exception: When using EMG as a baseline study to test pedicle screws, you may report as many units as necessary of 95870 (Needle electro-myography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinals, cranial nerve supplied muscles or sphincters). Explanation: "Code 95870 is used for limited study (fewer than five muscles) in one limb or non-limb (axial) muscles, other than thoracic paraspinal or cranial nerve," says Gloria Galloway, MD, FAAN, FABEM, professor with the Division of Neurology and director of the intra-operative monitoring program at Ohio State University Children's Hospital. "So, if you are only doing limbs, then the maximum is four units of 95870. If you add other non-limb muscles, however, you need to bill for those with additional units of 95870 as well." For instance, Galloway says, "If three of the muscles the physician tests are on one limb, that is one unit of 95870. But if you tested two additional non-limb axial muscles in addition to four limbs [for instance, when testing from pedicle screw sites], you would code for six units of 95870." Count muscles and limbs: If the monitoring physician tests five or more muscles from each limb, you would turn to EMG series 95860-95864 (Needle electromyography ...), depending on the number of limbs tested. 2. Watch Time Carefully You should report IOM using +95920 (Intraoperative neurophysiology testing, per hour [...]