Otolaryngology Coding Alert

Question: May I bill for facial nerve monitoring, such as for 100 minutes with a total thyroidectomy in a hospital setting?Illinois SubscriberAnswer: It depends on the insurer.Usual way: Medicare only pays for nerve monitoring when performed by a provider who is not the surgeon performing the main operation. You indicate that the otolaryngologist performs both the facial nerve monitoring and the total thyroidectomy. So for Medicare, bill only the surgery with 60240 (Thyroidectomy, total or complete).Rare exceptions: But some private payers allow the operating surgeon to also bill for facial nerve monitoring. When reporting intraoperative facial nerve monitoring, you'll need to use three codes -- one for the primary procedure (the surgery), one for the electrophysiologic study that accompanies the surgery, with the professional component modifier (26), and one for the monitoring itself.For the above scenario, report for the:1. total thyroidectomy 602402. professional component of the bilateral study 95868-26 (Needle electromyography; [...]