EMG nerve Monitoring

nsclark2

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We billed a 60240 with dx codes 240.9 and 242.00. We also billed 95865 with the same dx codes. Is that correct? 95865 is being denied for inconsistent dx. Also, do we need modifier 26 and 51 as well? :(
 
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We would bill it the following way:

CPT 60240
CPT 95865-26
CPT 95920-26 (X3 units) = 3 hours monitoring (intraoperative neurophysiology) depending on op note documentation clearing stating that monitoring was continuous for 3 hours during the procedure.

You need to bill 95920 (add on code) when you bill 95865, indicating it is "intraoperative" nerve monitoring, otherwise it appears very inconsistent with the thyroidectomy and diagnosis code.

The Academy of Otolaryngology website has some coding guidance with regards to intraoperative nerve monitoring.

BTW, Medicare will not pay for intraoperative nerve monitoring, but there is a number of private payors that will.

Hope this helps,

Jennifer
ENT CT
 

tzadqiel235

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EMG nerve Monitoring

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We billed a 60240 with dx codes 240.9 and 242.00. We also billed 95865 with the same dx codes. Is that correct? 95865 is being denied for inconsistent dx. Also, do we need modifier 26 and 51 as well?
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Nicole S. Clark, CPC-A


Hello Miss!
Clinically, the diagnoses represented by 240.9 [Goiter, unspecified] may refer to enlargement of the thyroid gland without imparment of function; while 242.00 is under the clasification of "hyperthyroid conditions....", that is thyrotoxicosis (hyperfunctioning thyroid with pertinent systoms). This makes the TWO separate diagnoses apparently "inconsistent". It appears difficult to reconcile the two diagnoses billed with the CPT code(s) being submitted; I think this is what they are having a bit of problem with, probably. In my experience, paying careful attention to the "definition(s)" of a diagnosis may help in assigning a code that "fits" the scenario, and also may facilitate reimbursment.

As for the Modifier 26: If somebody did [a] technical aspect of the procedure, then this modifier may be appropriate for the Pysician component. Also, one of the CPT codes would represent the Primary Procedure (eg, thyroidectomy); then Modifier 51 would be attached to the "additional" procedure (eg, intraoperative EMG nerve monitoring).
[If you disagree, please say so.]

Pylord P. Doe, Ph.D. [CPC Eligible/Exam Results Pending]
 
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