Otolaryngology Coding Alert

Audiologist ongoing auditory nerve testing falls under CMS direct-billing mandate With parotidectomy, mastoidectomy and acoustics, you can breakout continual measured testing if you don't use the ENT's national provider identifier (NPI). Try your hand at two case studies that highlight Medicare's criteria for billing 95920 (Intraoperative neurophysiology testing, per hour). Include Same Surgeon Monitoring in Parotidectomy See if you can spot the problem with the following scenario. An otolaryngologist would like to bill the following codes on one claim: - 42420 -- Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve - 95867-26 -- Cranial nerve supplies muscle(s), unilateral; Professional component - +95920-26-- Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]. Problem: "Intraoperative monitoring should not be billed by the operating surgeon but rather by the independent physician performing either the global service or the professional component," says Marvel J. Hammer RN, CPC, CCS-P, PCS, ACS-PM, CHCO, president of MJH Consulting in Denver, Colo. "Typically, the physician is either a neurologist or physiatrist (PM&R)." Alternative: A nonphysician practitioner who is not on the hospital's payroll could bill the intraoperative monitoring separately from the surgeon. Why: The Correct Coding Initiative (CCI) bundles 95920 into most, if not all, surgical codes, including 42420, Hammer points out. This bundling edit has a status indicator of "0," meaning no modifier can bypass the edit. Lowdown: The bundle applies on claims in which the same physician reports both the surgical code and 95920. Intraoperative neurophysiology testing (95920) "should not be reported by the physician performing an operative procedure since it is included in the global package," according to the CCI manual, Chapter 11. Think of it this way. CMS considers monitoring like surgeon-administered anesthesia, which Medicare treats as a nonpayable service. Report Separately Billed 95920 The edit does not apply if the surgeon reports 42420 and a different provider reports 95920 along with the appropriate baseline study code; "- when performed by a different provider during the procedure, [intraoperative neurophysiology testing] it is separately reportable by the second physician," according to CCI. Many Medicare carriers include additional restrictions in either articles and/or local coverage determinations (LCD) for intraoperative monitoring. For instance, one Medicare carrier article states, "As an additional physician service, 95920 must be clinically necessary," for example, necessary for patient management and not routinely performed by the anesthesiologist or surgeon. Caution: Before using 95920, check your major payers- policies. "Many commercial payers have intraoperative monitoring coverage policies and some specifically indicate non-coverage by any provider, for intraoperative monitoring during parotid surgery," Hammer notes. Bundle Same-Session Surgery, Test The otolaryngologist in the previous parotidectomy scenario should report the surgery only. "The physician performing an [...]