Oral Surgery Coding & Reimbursement Alert

You Be the Coder:

Understand When Nerve Monitoring During Surgery Can Be Reported Separately

Published on Thu Jul 30, 2015

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Question: Our surgeon recently performed parotidectomy on a patient. During the procedure, the facial nerve was monitored and preserved. Should this monitoring of the facial nerve be reported separately along with the code for parotidectomy or should it be included in the surgical service that was performed?

Oregon Subscriber

Answer: In order to understand whether or not you will be paid additionally to perform the facial nerve monitoring that was performed during the surgical procedure, you will have to elaborate the type of monitoring that was performed and who performed the monitoring.

If your surgeon who is performing the procedure is also taking care of the monitoring, then you will not be paid out for this monitoring service separately. Medicare and some of the other payers are of the opinion that the surgeon who is performing the procedure cannot pay adequate attention to the nerve monitoring beyond listening to a beep and this service does not support a separate payment.

However, if another person performed the monitoring, which includes watching a wave form and doing more than listening to beeps, Medicare would pay for the separate individual performing the monitoring. So, if another person such as a surgeon, physician assistant, nurse practitioner or any other qualified professional who within their scope of license can perform the monitoring, you can report the code, 95940 (Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes [List separately in addition to code for primary procedure]) for every 15 minutes of one-on-one monitoring performed.

So, you will only report the appropriate parotidectomy code (such as 42410, Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection) for the services provided by your surgeon. You will report the monitoring separately when the service is provided by another person and not when your surgeon is performing the service.

Note: You will have to report the monitoring service using the NPI of this individual who is performing the service and this claim should be separate from the surgeon who is performing the procedure.