Otolaryngology Coding Alert

Question: When an otolaryngologist performs facial nerve monitoring in an outpatient setting for 69641 (Tympanoplasty with mastoidectomy; without ossicular chain reconstruction), should I report the monitoring? Is this the intent of 95927 and 95920? Massachusetts Subscriber Answer: The answer depends on the surgeon's involvement and the payer. If the otolaryngologist performs the procedure and the monitoring, Medicare will not reimburse for the monitoring because the surgeon performed it. You may, however, bill third-party payers. If the surgeon provides the monitoring only, you may bill the study, such as 95927 (Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in the trunk or head), in addition to the monitoring (+95920, Intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]). Medicare treats same-physician-provided monitoring like same-surgeon-provided anesthesia. The payer includes surgeon-provided anesthesia and monitoring in the procedure and will not reimburse separately for either procedure. For example, Cahaba GBA Medicare policy 218 for Alabama and Georgia Medicare Part B requires that the operating surgeon request the test and that a physician perform the monitoring other than the:

operating surgeon
technical/surgical assistant
anesthesiologist rendering the anesthesia. For the complete policy, visit www.gamedicare.com/policies/218.htm.

Remember that 95920 is an add-on code, which means that you should report it in addition to the code for the study performed. Assign the study first, followed by the monitoring.

Bill the monitoring per hour. You may report an hour after 31 minutes. So for 90 minutes of monitoring, report 95920 x 2. Include the start and stop times for the monitoring. The 2002 National Physician Fee Schedule Relative Value File divides the study code and the monitoring code into professional and technical components. If the physician does not own the study or monitoring equipment, append modifier -26 (Professional component) to the applicable codes. Clinical and coding information for You Be the Coder and Reader Questions provided by Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J; Bechara Y. Ghorayeb, MD, PA, an otolaryngologist with Otolaryngology-Head & Neck Surgery in Houston and clinical associate professor of otolaryngology at The University of Texas Medical School; Tara R. Kay-Ritter, appeals coordinator, Atlanta ENT, Allergy & Asthma Associate PC; and Charles F. Koopmann, MD, MHSA, professor and associate chair of the department of otolaryngology, physician billing director, and a member of the faculty group practice at the University of Michigan in Ann Arbor.