Intraoperative Neurophysiology

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Show Low, AZ
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My Neurologists perform this procedure remotely, monitoring multiple patients at any given time . CPT 95920 was replaced by 95940 and 95941 for 2013.
According to the fee schedule, 95941 is not a valid code for Medicare, which is what my physicians do.
Would appreciate input as to what some of you Coders may be doing with this?
Thank You.
 

kmc617

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We are trying to figure out these new codes too! They also look like they can be billed globally vs. TC/PC, but with 95940 & 95941 being add on codes not sure how this will work; very confusing, so if anyone can offer their expertise that would be great!

It appears that the Medicare code is G0453.
 

sadieandbrian

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Just wondering if either of you have had any good outcomes on billing of the neuromonitoring for 2013. What I'm finding is they (commercial payers only, we haven't dealt with Medicare yet) are only allowing 95941...but not allowing the other codes we're billing along with it (95861, 95937, 95870). Seems odd they would pay for the time but not any of the other CPT's?! We're appealing but nothing back yet, just wondering if you're having the same problems or not.
 
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Please keep us updated, I do intraoperative neuro monitoring and am having a very difficult time getting paid. We started using the 95941 code under the reading physician, then switched to 95940 under the individual tech, and nothing seems to work. I keep getting denial after denial. :confused: United Healthcare is saying that we can not bill these codes with the TC modifier, only the hospital can, but the hospital does not bill for our tech services, I don't understand....PLEASE HELP me!!!!!!!!!!! Any suggestions would be greatly appreciated.

Thanks,
 

sadieandbrian

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We are billing professional, so have 26 modifiers on ours. We were also told by United Healthcare that CPT 95941 does not allow for any modifiers (TC/26), but they didn't mention this for the other CPT's that we bill.
Very frustrating. Just rec'd several denials from workers comp as well. They'll pay 95941 but none of the other codes I mentioned earlier. Doesn't make sense that they're all paying the "add on" code only.
 

kvangoor

Guru
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Grand Rapids, MI
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Here is a Q &A from my medtronic rep. Might be helpful for you

Q: What are the new 2013 CPT codes for intraoperative monitoring?
A: CPT code 95920 has been deleted effective January 2013. Three new codes (95940, 95941, and G0453) have been added. New code
95940 is reported per 15 minutes of service and reports only the time monitoring provider was physically present in the operating
room providing one-on-one patient monitoring. New code 95941 is reported for non-Medicare cases in which monitoring provider
is not in the operating room or when provider is monitoring more than one case. These codes should be used in conjunction
with the study performed: 92585, 95822, 95860-95870, 95907-95913, and 95925-95939. Do not report these codes for automated
monitoring devices that do not require continuous attendance by a qualified professional to interpret the testing and monitoring.
Medicare Note: 95941 may not be used for Medicare beneficiaries because it allows a provider to remotely monitor several patients at the
same time. CMS now allows a provider to monitor only one patient at a time, so G0453 is used for continuous remote monitoring for one
patient (outside the operating room).
Q: How has Medicare changed its coverage policy for intraoperative monitoring?
A: Medicare will now allow a provider to monitor only one patient at a time (95940 if in the operating room and G0453 if outside the
operating room). Time billed is based on actual monitoring time. Physicians may bill Medicare for one unit of G0453 if at least 8
minutes of service is provided as long as no more than 4 units of G0453 are billed for each 60 minutes.
Q: Who can bill for intra-operative nerve monitoring (IOM)?
A: Criteria for commercial payers may vary, so physicians should contact their provider-relations representative. Under Medicare rules,
the operating surgeon is not paid separately for IOM. The following providers can bill if they have a separate provider number from
the operating surgeon:
• A physician who is not performing the surgical procedure
• An audiologist trained and certified in electrophysiologic monitoring
• A physical therapist trained and certified in electrophysiologic monitoring
• A neurophysiologist, neurologist, or physiatrist
Q: If the operating surgeon’s partner performs the nerve monitoring, can this be billed separately?
A: In general, the operating surgeon’s partner cannot bill for nerve monitoring separately. From the payer perspective, a physician and
the physician’s partners is the same person. Since the operating surgeon cannot bill nerve monitoring separately, a partner cannot
bill separately. One common exception is when the operating surgeon and the partner are in different specialties, in which case
some payers allow them to bill separately. (Medicare Claims Processing Manual, Chapter 12, 30.65.) Criteria for commercial payers
may vary, so physicians should contact their provider-relations representative.
Q: Can hospital outpatient departments or ambulatory surgery centers bill for intra-operative nerve monitoring?
A: Under Medicare APCs, the hospital and/or ASC can bill for the technical component of the EMG codes, such as CPT 95867 or CPT
95868 and receive separate payment. However, Medicare considers the intraoperative nerve monitoring codes to be a “packaged”
service. The hospital and/or ASC can and should submit the code, but payment for 95940, 95941, or G0453 will be included in
the payment for the primary procedure, so no separate payment is made. Contact your commercial payers for specific payment
information on intraoperative monitoring.
 
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??

OK....I think I might have this figured out. There is no indicator attached to the new IOM codes 95941/95940 - meaning we are not able to bill these with any TC/26 modifiers.. Anyway, since the new codes are add on codes just like the old one, I'm going to try and bill my claims with 95940 with no modifier...(since I'm only billing my Tech charges, not the professional.) And the rest of modalities I will attach the TC modifier...Its trial and error right now with our office, and very confusing...

Does anyone have any input on this?:p
 

sadieandbrian

Networker
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That is exactly what we have been trying. 95941 with no modifier...and the other CPT's with the 26 modifier. However what we're finding is that they are only allowing & paying the 95941...and denying the other ones. Which is odd they would pay the add on code but not the other codes?! Our workers comp through Wyoming is using the new code (not 95920) but again they are only paying for 95941 and denying the other procedures. I have a call into them but haven't heard yet.
 

Anita Morris

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Local Chapter Officer
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Question: If intraoperative monitoring is being performed on Inpatient only procedures, and the facility is providing the service through a vendor who sends a tech to actually perform the monitoring, and the facility pays the vendor directly for the services, can we report this on our Inpatient claims?
 
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Location
Gallatin, TN
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IONM Billing

We bill the 95941 with a 59 modifier (no 26 because it's a professional only code). Because it is an add on code, I will bill it last. We are getting paid for monitoring.
 

Cindy Akkerman

Networker
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Newalla, OK
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IOM Billing

Check the contract with the vendor to determine the billing. Some contracts will have the vendor do all the billing, part, or none. The contract will determine who is to bill and what portion.
 
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Location
Lindstrom, MN
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Please help, 95940 and 95941

We bill the 95941 with a 59 modifier (no 26 because it's a professional only code). Because it is an add on code, I will bill it last. We are getting paid for monitoring.

Michelle,
We have two payers who do not want to pay units for codes 95940 and 95941. I have a claim here that our billing manager asked me to work on and I'm wondering if you or somebody could help me break it down into how it should be billed with the 59 modifier added...

Specifically here are the codes:
95937-26
95961-26
95938-26
95939-26
95940 15 minutes
95941 5 hours

We had an account follow-up person working these claims up until about two weeks ago. She quit and now our billing manager has taken over in the interim. She said the codes 95940 and 95941 will not even be accepted by the clearinghouse on the computer system if done as units (I honestly don't know how they were being inputed before as this is the first I've heard of it). Anyhow, any help I could get would be very much appreciated. Either answer on the forum or send me a private message. Thanks a ton!
 

sadieandbrian

Networker
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We bill CPT 95941 all of the time on our neuromonitoring claims, times the # of units/hours. We don't put any modifiers on it. We normally don't have a problem getting them paid, but if they deny that code we just send in an appeal stating it's an add on code & is separately payable & most of the time they'll come back & pay it. Include a copy of the insurances policy on neuromonitoring if you have it (from their websites). A couple of the payers don't accept 95941 and instead want G0453, so we've just learned which payers want which code & bill appropriately.
We don't bill CPT 95940 at all as our neuromonitoring is done outside the OR so we aren't able to use 95940.
 

sadieandbrian

Networker
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We've just learned by trial & error which carriers want G0453 and which want 95941. It has taken time but we are now getting paid for most of the neuromonitoring codes. From my experience, Medicare, BCBS and Triwest want the G0453. All the commercial payers (ex Aetna, UHC, UMR, Cigna & workers comp) want 95941.
 
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Thank you SadieandBrian. Now, these codes 95940, 95941 or G0453 are add ons, so they need to be billed with primary procedure codes right? I read somewhere that insurance was not paying for add on codes but paying on procedures only. Medi-Cal (Medicaid) does not accept G0453 right?
 

sadieandbrian

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Our office has actually chosen not to bill any of these to Medicaid so I'm not sure on that.
Yes, they're add on codes so have to be billed with the other primary procedures.
Originally we were getting denied on the 95941/G0453 add on code & insurance was paying the other codes. It's actually gone back & forth, it's quite a battle to get paid in general. At one time we were only getting paid for the 95941 & none of the other procedures. Other times we get paid for all the other codes & they deny 95941. It really just varies across the board. We have to appeal a lot of them & usually with an appeal they will come back & pay the remaining codes.
 

Faith56

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Billing globally

I am brand new to this site...it is so exciting to find some support in this IOM billing world...so many unanswered questions!!

Does anyone out there have success with getting the TC portion of the codes paid? I bill globally for all the codes since TC and 26 are built in the codes but hardly ever get paid for the technical portion!

I started billing with the TC modifier and the 26 on 2 lines and that did not work...has anyone heard of billing the technical part with a 59 modifier?

I am talking about the primary codes 95938, 95939, 95937, 95861 etc.

Thanks!!!
 

jmacias50

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IONM Billing CPT code 95940 and CPT 95941

Based on billing practices can 95940 be billed as a technical fee along with 95941 as the professional fee if there is a clinician in the OR with the patient monitoring while the neurologist is monitoring the case remotely. Or are these codes both professional codes?

Would appreciate your input as to how you are billing these codes.

Thank you,
 
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