Wiki Intra-operative Monitering (IOM)

[brieghm]

I recently began working at a compay who has certified technicians that provide the IOM to the spinal cord/ nerve roots for physicians during spinal surgery. This is to reduce permanent complications due to the surgery. My problem is Insurance Companies are denying us payment stating, "the procedure we performed is expirimental/ not medically necassary". The CPT codes we PRIMARILY use to coincide with the physicans CPT codes are:
95920;95822;95925;95926;95927;95861
We use modifers 26/59 where needed, but we still get denied by the big insurance companies, especially when the patient DX are stenosis, radiculopathies and HNP's. I know this question is confusing, but does anyone know or can suggest another code, modifiier or maybe know some resources I can look into to help us out? I am the only coder here and I am stumped. Any advise is welcome!!!

 

[nidhim]

Intra-operative Monitoring (IONM)

Per Medicare guidelines, Stenosis, Radiculopathy and HNP's are not a covered dx for IONM services and as a result these are not covered services for reimbursement. You can though try appealing your claims by providing a letter of medical necessity as to why Surgeon requested these services. I know this is a time consuming and extra work but sometimes it works. Hope this helps.

Nidhi M, CPC
www.symbiosisbilling.com